Category: Value-Based Care

Why Wellness Should Be The Core of Value-Based Care with Adrienne Nolan-Smith, Founder at WellBe

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Why Wellness Should Be The Core of Value-Based Care with Adrienne Nolan-Smith, Founder at WellBe

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 to the podcast. Today I have the amazing Adrienne Nolan-Smith. She's a Founder at WellBe. She's a speaker, a board certified patient advocate, and a wellness activist. I'm excited to bring her on the podcast today because the fact is wellness is important and as we turn a chapter from fee for service to value-based care, wellness is starting to become more important. So it's with pleasure that I invite Adrienne into the podcast. Welcome Adrienne.

: Thank you so much for having me Saul.

: It is a pleasure. So Adrienne let's chat about WellBe you know tell us a little bit about what it is. Tell us a little bit more about you. Anything that I missed in the intro let's hear it.

: Absolutely so my hodgepodge of titles came from several decades of different experiences with health and wellness to just start from the beginning. I was diagnosed with Chronic Lyme Disease when I was 11 years old and basically my mother was told that there wasn't much that could be done after the antibiotics didn't work because I'd had it for too long already for the antibiotics to really be able to cut off. And so it started my family down a new path which was integrative medicine and you know this is in the mid 90's and it is very different from how it is today and definitely was seen as sort of hippie and wuwu and off to beaten path and all of the practitioners that I saw I definitely felt that way you know I was like a middle schooler and they seemed weird but the difference I realized was that through doing all these different treatments and therapies with them and we did a whole bunch of both things that you know you may have heard of. And things that are you know really out of the box but are actually becoming more popular today like hyperbaric oxygen therapy and things like that. I was healed. My Lyme was inactive by the time I was 13. And this is pretty remarkable because people really don't heal very much from Lyme once they've had it for you know a couple of years undiagnosed. So it kind of changed the course of my family's living habits and lifestyle as far as what we knew was important to both keep that disease in remission but also to just boost your immune system to prevent other health issues from coming up. And so you know we only added health food stores and saw a lot of different practitioners as part of a general protocol and took a lot of supplements and things like that. And you know nothing. I was in fantastic health until I was about 18 and I went to college at Johns Hopkins which is funny because now that I'm in the health and wellness world people always ask me you know if I'm a doctor and I'm the only girl in my sorority family who's not a doctor because so many people go there for that. But it just makes sense of course now that I got into this field. But when I went I you know again eating in the dining hall and within six months I had completely lost my menstrual cycle. And this was really bizarre you know and having never happened to me before and having one since I was 12 and went to see a whole host of endocrinologist and gynecologist and trying to figure out what was wrong. And you know they they just kind of run some blood tests and they said you know we can't really see anything you seem to be in good health. No changes in your weight whatever. Just take the birth control pill like this was you know the solution that I was given and luckily because of the Lyme experience I knew to do a lot of research before you have any kind of encounter with a doctor. And I said you know with all due respect like that that's actually not a solution. Like that's a bandaid. That's kind of masking a symptom. You're going to give me a fake period but I want my real one and I want you to help me get it. And if you can do that? Thanks, but you know I'm going to be on my way. And so you know I went through several of these maybe eight weeks and finally both at Johns Hopkins and back in New York where I'm from. And finally my father found me a naturopath after I'd exhausted a lot of the conventional options and we looked at the blood so differently together and spent you know more than an hour on it. Going through it all and talking about my different experiences and living in China and whatever and even emotional stuff that I was going through at the time as my parents were getting divorced and whatever and within six months of diet and supplement and Chinese herbs protocol that I was on with her. It came back and it's been you know totally normal for the last, over a decade. So...

: That's awesome congrats.

: That was like. Thank you. It was like episode number two of like whoa you know this is a messed up system. Right. And what am I missing, what are most people missing? Like thank God I had the stubborn attitude to actually go in and the finances honestly to go see all of these different intake appointments and a lot of them you know don't take insurance. And my family so believes in health that it was something that you know my parents would still pay for but I can't even imagine getting to the root cause of things without that. So that's a whole note of topic. But the biggest thing that happened to me and the reason that I'm founded WellBe and I'm doing what I'm doing today came when I was about 20 years old my mother had a manic episode and basically paranoia, delusions, middle of the night to put her to the back of a cop car. She thought we were trying to kill her. Was like a really crazy thing. She ran away from us all the way to Queens and we had to sort of like restrain her and basically it started you know a real nightmare. It was five years of the revolving door in and out of mental hospitals. And she was diagnosed with schizo affective disorder which is a combination of bipolar and schizophrenia and I've never had anybody that I knew have any mental illness per se maybe depressive or anxious symptoms but not like this and this was a really rude awakening to the mental health care system which if we think the regular health care system is bad like that system is just...

: Another story.

: A whole nother level of you know just kind of not getting to the root cause of things. And so when I was 25 she was so heavily medicated and such as zombie from all these drugs and she's drooling and shaking and all of that. That she you know I totally understand she found it not to be a suitable solution. Like it wasn't actually a better way of life at all. And she took her life and...

: I'm so sorry.

: It was thank you, it was a couple of days before Christmas. And at the time I was applying to business school. I'd been working at IBM and I knew that wasn't my calling. And I knew I wanted to do something that was meaningful to me and where I could really tap to change something worth changing and be a part of something that was important. And as I'm not even sure how I'm going to finish my applications because it was about two weeks before my applications were due and I kind of my friends were incredibles, came together, helped me edit drafts, scott you know one or two out the door and I was very fortunate to get into the Kellogg School at Northwestern where I went in Chicago and I told myself if I got in I would dedicate the rest of my life and use business school as the transition tool to work on transforming the health care system into one that actually gets to the root cause of health issues and doesn't just bandaid the symptoms. More my mom had a ton of other sort of gut issues and early traumas and things like that that I had no idea could be connected to mental health issues. Of course a lot of us didn't with the Microbiome Project hadn't even the results really hadn't come out. We didn't know about the gut brain connection and so had anybody kind of dove deeper and started to peel back the layers instead of just the drug drug drug you know we could be in a really different place today. And so my whole thing with that I'm trying to do it with WellBe which is a media and lifestyle company dedicated entirely to helping people prevent and reverse chronic health issues and really see the hundred choices are making everyday as health care. And then when they do have a health care experience of any kind in the conventional system understanding how to advocate for yourselves so that the people you work with get to the root cause and heal you rather than mandating symptoms for indefinitely I guess. So that's all of why I'm doing what I'm doing now. We make all original content I film people's stories of health recovery through integrative medicine but also a lot of experts that are MDs and naturopaths osteopaths who sit at this intersection between health care and wellness to try to show that there are people doing great work here to try to destigmatize it a bit. It's not all hippies but also bring a lot of research to the conversation that I'm able to see and Medscape and pub med and all of that to show that you know the whole argument is oh wellness isn't science like no it really is and a lot of great work is being done right now to show that.

: I think it's such a such an inspiring story Adrienne and it's wonderful that you're doing this. Folks if you want to check out some of the work that Adrienne and her crew are up to, go to getwellbe.com that is their website is. An incredible story and now very mission-driven business that she's running here. I think it's a beautiful thing because at the end of the day not everybody gets the results that they want from the health system. And so it's great to have another option and this option is there for as Adrienne mentioned chronic illnesses that you know you just can't seem to get the source of and I don't know and you know it just seems to me like there's a lot of things in the gut that sort of don't have all the clear answers right.

: Oh yeah I mean the more we learn the more I'm realizing I would say like 80% of chronic health issues somehow relate to just an imbalance of good and bad gut bacteria and how that then spreads into the brain and affects the immune system and creates chronic inflammation which leaves all these other things and it's like honestly peel the onion and somehow there's always that gut at the bottom. Seems to be controlling most things with just extraordinary. And I forgot to mention in my story that after I graduated from business school I worked in conventional health care for three years with hospitals on the patient engagement software side of things so I was working in health tech so...

: That's pretty cool.

: I was able to see kind of in these hospitals because I worked on chronic disease management programs and when you were talking about value-based care it actually might be because that's what I was working on a lot trying to help hospitals reduce 30 day readmission. And you know really get people bundled payments and all this sort of thing with population health management and it was originally I thought maybe I can solve this from the inside maybe I can work in a way that that does that. And I just saw that there were just so many incentives to keep the system to be you know not only fee for service but really based around a disease code. Right. And we all know that a lot about preventing chronic illnesses. It must happen before you have a disease. And a lot of the treatments related to healing from chronic illness aren't seen as a disease code right. So acupuncture or supplements those are not exactly seen as I did seem like complimentary treatments or something right. So if the system is constantly related to this DRG thing this disease code thing there's just no way that people can really pay for any steps they might want to take to heal or prevent chronic health issues and those can even be the things that we know of that start in a small way. Right. Like you just have migraines or you just have a little bit of pain that you're kind of like take a lot some Advil for and then more and then more then more and the sade's end up really harming your gut bacteria which leads to a whole bunch of other things. So something that small can really, you know we talk about chronic disease but it's really just chronic health issues because if you don't get them and heal them and you just manage them whatever you're doing to manage them can end up causing a host of other health problems so that's something I think that is really important. And what I learned when I was working within the conventional system.

: Yeah and it's cool that you had that experience obviously you're coming at this from from a very informed perspective both as a patient but also as a as a professional within traditional health care system and I think you sort of highlighted a very important thing that the way that our system is built and the way that we do billing and procedure codes it's not set up to pay for a lot of things that could potentially be helpful. And so you mentioned earlier in your story "hey you were fortunate to have an ability to to pay for an alternative let alone know what the alternatives are" right. I think it's cool that you're doing this because part of the battle is understanding what the alternatives are. And so folks if either you or somebody that you love is going through some chronic illnesses and I'm sure you could think of firsthand somebody that you know I know to three people right now and so I'll be referring them to your podcast and to your thing Adrienne because folks by the way Adrienne also has a podcast. She's podcasting with folks that are you know doing well after not having solutions to their chronic illnesses. She's covering things like integrative medicine and the microbiomes so definitely check out that podcast. Again you can check her out at getwellbe.com you'll see a link there for it. But yes so kudos to you for bringing forth this forum of discovery that I think a lot of people are needing.

: Thank you. Yeah I know when I was going through my own health issues as well as taking care of my mom. Where do we all go to search for information about health. We go to the Internet and so but when you Google something it's really both an SEO game and just you know whatever happens to be there in the way that you put it in. But a lot of the best information you know is either kind of behind research walls that you wouldn't necessarily see in Google or in some of these smaller more mission-driven sites. And so what I found was being able to see what other people, what had worked for other people who may have had my exact health issue or even like as you said I know now so many friends and family are going through things now. So being able to help them and you just how are you what's going on there like a you know my skin. I feel like I can't go outside. You know one of my best friends it's just this ongoing saga and dealing with it is not only exhausting. She's sort of given up because she's been doing it for so long. But emotionally so trying because it's now this kind of like it's part of your identity. Right to have whatever that's chronic health issue is and it feels like climbing Mount Everest to think that what you'd have to do to get rid of it it may not be that complicated. Just maybe one more person that you try to work with. One different kind of practitioner you hadn't thought of or one treatment that is interesting to you. But you know somehow you never read about it maybe just you need and so this is what I've seen with these videos when people share their stories and they truly did heal people. Look at that. So differently and say well I have rheumatoid arthritis. I didn't even know it was possible to reverse it or I have Hashimoto's. Like how did they get over that or systemic lupus like are you serious you went from chemo to existing without drugs and she's fine. Like how is that possible and so by sharing both these stories but also coupling it with a lot of the research that we cover and a lot of the experts whose work life work is just these particular topics whether it's the gut microbiome or acid reflux ENT Dr. I covered who now only treats patients with diet based on you know having been a head and neck surgeon and saying that's not the answer. I don't want to take out tumors anymore. I know it's all diet. I'm just going to work with patients that way. So lots of different kinds of things but all related to this idea that our bodies are incredible. And for chronic health issues or diseases it just takes certain therapies and practitioners and lifestyle changes in order for your body's immune system to kick in and really heal. Now of course there's emergencies and there are life long genetic conditions that you're born with that maybe can't be solved that way or they. But I believe the statistic is that 80% of all of American health care costs are related to the ones that you can do something about. And you know really only five percent of June mutations are actually determinant or you know unchangeable. So I think that's just an amazing opportunity for the majority of people who right now are like "I don't want to take all these drugs. I don't want that surgery. I don't want to have to get so much radiation. I don't want to I don't want to say try these other things first like get to that choice 10." You know when you really have exhausted everything else. But before that can you imagine you can live your healthiest life just the way that your body is without having to be dependent on anything.

: Yeah not a... some great thoughts being shared here Adrienne. And you know I would even extend this to people that don't have chronic illnesses because at the end of the day if you want to be well you really have to start looking at what you are consuming and the treatments that you're getting because a lot of things that end up affecting us are the things that we think are good for us or that we don't know and that ultimately gets us. So some great shares give us an example maybe a story of somebody that was inspired to wellness through your work.

: Yeah I'd be happy to so we get you know some terrific comments and people writing and just on the forum on our site when they've seen something and then they you know go to see that doctor and they didn't really know something was possible before. But one of them is a friend that I have and you know her child has asthma and she had no idea that it could possibly be related to diet. And she saw some research on our site where we covered this connection between asthma and the child's microbiome. And the mother and things that related to nutritional deficiencies which comes back to diet and she sort of just had this whoa like and then she's now kept reading and she saw another research piece that we had covered relating a lot of plastics and other toxins within the home to asthma and she was surprised to see that as well she always thought it was just a respiratory condition. But what people don't think about that much is that asthma is just your blood and your lungs are are quite linked hence why these other cancers develop elsewhere in the body when you smoke right. That's not it. The lungs are not isolated. That's what I mean. So these other toxins were getting into her child's lungs and causing this disease via not really thinking too much about what she ate and using a lot of toxic household products and you know even her diapers were generic and had lots of chemicals on them and she really hadn't thought about it and it kind of started to unravel for her the idea that something she thought she was just going to have to treat with steroids and inhalers and things like that for the rest of her child's life that not only were those steroids wiping out the small microbiome that he has and the good gut flora there but also there were things she was repeatedly exposing him to every day with these products as well as with his diet that were continuing to cause inflammation and therefore cause also asthma which is just inflammation of this particular lung condition.

So it was just a really neat way for you know not having to even push it. Exactly. But just it was one of the topics in our research research piece. And she wasn't reading it even thinking about her son per se but yes she's my friend and all of a sudden these things started to click and she started to kind of realize that she had to really clean out things in her home and in her kitchen and especially the product she was actually using on her child which again from a marketing perspective we thought, these are healthy, these are American household brands. Yeah. And then oh my gosh. And using environmental working group database and some of the other things that I told her. You know look out for in the agreement she discovered actually not at all. I am exposing my child to a really big array of chemicals and I need to get all of that straightened out and let's see if the asthma you know just clears up that way. So that was just a few weeks ago and I thought that was kind of a really neat turnaround in that hearing about it. Yeah. So that's one that I know of so far. And then most of well anyway I'll let you ask me another question.

: And that's good. So for the folks out there that you know have basically tried everything and you really don't know what to do. I feel like this opportunity that Adrian has created and get well be is is really something that will offer inspiration to those looking for a solution where they haven't been able to find one in the traditional health care system. So definitely something to consider if this is you I'll be putting on the show notes as well as a full transcript of our discussion at outcomesrocket.health/getwellbe just as it sounds and just like the website so you'll find that there. Give us an observation that you've made Adrienne of a setback something that that happened that you learned so much from that now you don't do things differently.

: Sure. Would you prefer. Like you mean one in like a work experience or one that I went through and my kind of health journey?

: You know what I think I leave that up to you because we definitely have been discussing a lot of both. So whichever one resonates with you the most.

: Yeah well I guess I sort of mentioned a setback certainly was my mom's experience. That one is the kind of clearest setback that I can think of as far as different things that I experience and how I, so I didn't know anything about the mental health care system before. And I would say that my biggest takeaway from that is that as I'm sure people on your show have talked about before but the disconnection between all the different specialists in the healthcare system and not feeling like anybody's actually looking at the body holistically I thought was really interesting. We were just given scripts right away scripture scripts and each drug had a host of side effects that then required other drugs so then you're sort of on a cocktail and you know anybody who's taken antipsychotics knows that it's really it's like being drunk all day on your liver, as far as the damage. And so I was just completely shocked that there was nobody in this system and these were very good doctors at Clane Hospital in Boston and they claimed you know good good good hospital looking at actually her body and saying Whoa these are powerful like we need to be doing a lot to detoxify her organs at the same time because this is not just a normal toxic burden like this is heavy duty. And so also is she getting enough of these green vegetables which will help her to actually detoxify her pancreas and her liver and all these other things as well as are we doing things with supplements to really expedite that detoxification process. And then you know the therapist that she's supposed to be talking to really is hard checking in with the psychiatrist who is prescribing things right. So that was kind of funny and interesting. But then on the what I think is the most interesting piece is the gut, the blood tests and all the different testing that could have been done on these underlying viruses and conditions which we now know impact the brain. We're not even part of the conversation. So you know whether it was like a gut health protocol that they could have put her on or things like that. There was just no sense of understanding why is this happening. And what are the different things that we can do to improve the different systems in the body such that we maybe can get her off these drugs and use this and actually restore her to a life in which it's you know she feels she's living because the vegetable state was not really living. So I learned a lot about this kind of lack of communication between specialists and then I also learned about you know how little the whole body is taken into account when prescribing things and also hardly any mention of the side effects which one of them was suicidal ideation and that is what happened. And you know we really didn't know about that. So you know it's hardly spoken about before you actually give somebody a script and then I also learned about I say those are my three biggest takeaways and the set backs that I saw. Yeah those, is that?

: No it's definitely clear and a lot of people go through this. You know you really don't know what you're getting into. And so it's important that you do the research and you get as informed as you can. But ultimately we have work to do in health care. We've got to connect these silos better and treat the body as a whole because it's definitely not being done as properly as it should be and especially with the cases that come up that are particularly difficult with chronic diseases. It does become even more more challenging. What would you say one of your proudest experiences in the healthcare space has been to date?

: Well certainly my life's work and my mission is definitely WellBe it's you know everything that I care about. And I unfortunately think that we have enough work to do that I'll be doing this in some capacity till I'm 90 years old up unless you know I do a really good job and the entire health care system transformed before then I doubt it.

: Me too.

: There's just way too many people really invested in. Unfortunately the way it's set up right now it's lucrative in some areas and I don't think anybody really wants to change that. You can't patent broccoli right. Which is why I always say. And so I would say my proudest moment would comes routinely when I get this outreach honestly from people who say something that we've done has sparked has lit a light bulb in their head that they didn't even know they sort of either accidentally watched it or they weren't even looking for something and they just it was something in their life or their family's life where they thought that was just the status quo that was just never going to change. "Oh I have anxiety or oh I had acid reflux or oh I just have high blood pressure". It's hereditary or you know these things that they were just like accepting as fact and saw as either research piece or an expert interview or you know story that we filmed or even one of our like article guides to something and just kind of didn't realize that there was a different way of thinking about something and that this was not a life sentence and decided it was really impassioned enough about that realization that they had to write to us. We're very active on Instagram as well. So I get probably a direct message like this you know once a week on Instagram but also writing into our site and each time I get one all the anxiety and stress and complications that come with being a sole founder as I'm sure you know Saul they just kind of melt away for a couple of minutes while you realize like wow I'm impacting people and it is not just about growing a brand or growing a business it's about like as I'm doing all of that. This person is able to maybe save their life if they're having this issue in their mid 20's or 30's and they are going to never really think there is a different way of looking at it indefinitely. Maybe I just changed the whole trajectory of their life. And so for me that's definitely each time that happens I just like beam from the inside and then I go back to work because I have so much to do.

: That's too funny. And for sure it's like that that affirmation that what you're doing is making a difference. And so folks the call to action they have something that you heard today is resonating with you. Check it out and share with a friend. That's the way that silos are connected right. That's the way that we are able to make a difference in this health care system is sharing it what you find impactful. And so I know I'll be sharing this interview with some personal friends and so I encourage you to take that as a call to action for today. I know are running out of time here Adrienne so what I'd like to do is just ask you for your closing thoughts and then the best place where the listeners could get in touch with you.

: Of course. Yeah thank you again for having me. It was great to speak to you. And you know as I said before I started this not because I thought there needed to be more wellness content on the Internet. Lord knows there's plenty of it but it was more that for me having done just worked in conventional health care for several years and seeing the issues you know every week that I was in a hospital, I know that everybody has to interact with the conventional health care system at some point you know whether it's they actually have something or just checkups and screenings and things like that. And then knowing that the wellness movement is booming. But you know a lot of people think it's just leggings and juicing and you know all of that and like grain, lose weight and all that stuff and I'm like whoa you know these two things like have to come together or because we are in a chronic disease crisis. I mean it's an completely unsustainable amount of disease that we've created in such a short amount of time that we're going to literally bankrupt ourselves and all die way too early as this continues at this rate. And so I thought it was something very important that I could do to bring to the conversation look I've seen both sides. I'm a wellness and integrative health person by you know passion, by experience but I've also been working in the system and I know that once they come together, once you bring that data that research and science to these things that can prevent and actually heal the root causes of disease rather than bandaiding symptoms. All of this will start to change and will start to change pretty rapidly because you won't have these crazy costs and you won't have so much disease that we know that the health care system as it exists can't even handle it which is exactly was happening. So that's what I'm trying to do and I hope that you'll visit WellBe and find us at getwellbe.com. So as Saul said it's getwellbe.com and we're also very active on Instagram. It's also at getwellbe's you can follow us there and if you don't have instagram, also Facebook and YouTube all of our interview and interviews and other content is there. Our weekly newsletter on the website which is definitely the best place to serve get new content because it comes out every Wednesday and has only podcast episodes and things like that as well. So yeah. Any way that you want to interact whether you know what to listen to a story to be inspired or read some of the research that we break down and cover in kind of a quippy way I think you'll get something out of it. I say if you have a body you probably will get something out of it because...

: Love that, love that Adrienne. Hey well this has been a pleasure. So folks make sure you check out Adrienne's podcast, her website. Again Adrienne this has been a pleasure. And really thank you for spending time with us.

: Absolutely. Thanks again for having me Saul.

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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What it Takes To Succeed in Healthcare Entrepreneurship with João Ribas, Biotech & Life Sciences Investor at Novo Holdings

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What it Takes To Succeed in Healthcare Entrepreneurship with João Ribas, Biotech & Life Sciences Investor at Novo Holdings

: Welcome back to the podcast today I have the outstanding Joao Ribas. He is the Co-Founder at The Future Labs Healthcare and Life Sciences Investor at Novo Seeds. He's a Harvard trained Bioengineer working at the intersection of Science and Business. He's passionate about empowering entrepreneurs and startups to succeed. Today he's phoning in from his new destination in Copenhagen Denmark which you know we had a great discussion about some of the happiest people in the world maybe otherwise their healthcare being part of it. He's an innovator he's done venture creation. He's he's got investment experience. And so I'm really really excited to have him here on the podcast so Joao welcome. Why don't you fill up that gap any of the intro that I may have missed out? Welcome.

: Thank you Saul, it's great to be here and talking to you on the Outcomes Rocket podcast. I think that introduction was pretty amazing. I didn't even know I did all these things.

: You're a humble man. You're a humble man. I appreciate that about you. What got you into the medical sector to begin with?

: Yes. When I was growing up I always showed curiosity about how things work especially biology and disease do. And for me working in solving healthcare problems sort of ticks that curiosity box. So that was one of the factors and then at the same time working health care means that I can impact positively the lives of millions of patients which is something I strive for. So I think those two as what sort of draw me into work in this medical sector.

: That's amazing. So now with the work that you're doing in this investment firm and with your own gig I think you have pretty good reach as you've looked at different companies Joao and you've done projects of your own like the X Prize etc.. What do you think a hot topic that needs to be on every medical leaders agenda today is and how you and your organization approaching it?

: Yeah although there's a lot of very hot areas that one could look into. But I think in essence what we're trying to do here we are we're sort of creators of opportunity. So we're looking for and we fund compelling and very strong science-based startups which will then lead to development of new territories where some of the most pressing clinical needs that we have out there. But of course in order to do this well we need to start early in the lifetime of the companies and then the ideas we need to back need to be transformative. So I think this is what should be on everyone's agenda is to find these transformative companies in a lot of different fields because there's different medical needs in a lot of different areas and fund these transformative companies and not just companies that are adding on to previous technology or just smaller improvements over what we have out there.

: So how do you how do you define that transformative?

: So we think about ideas and companies that really disrupt the way we're looking at a treatment of a certain disease or therapies forced into a disease and can bring an angle that no one was really thinking of before. So you can think about the CAR T the cell therapy as something that was very different from what people were doing. So we're looking for the sort of opportunities where you see that there's a different approach to things.

: Got it. Got it makes a lot of sense. And so as you've embarked on this journey to work with and fund transformative companies, can you give listeners an example of maybe one of those companies and their solution and what they're doing differently to improve outcomes?

: That's an excellent question and it's kind of hard right now to give you a specific example because we often don't talk about some of the companies that we invest in because it's such an early stage and some of them might be sort of under the radar but there's plenty of companies out there that are interesting I can give you another example of a company that I know closely from the time that I was working in the U.S. there was sort of a very simple idea a sort of disrupted a little bit the way people were doing things and this was while I was working there in Boston so this company looked into the problem of compliance of adherence to medication which in the U.S. is a really big issue. A lot of people were developing a lot of different solutions. You know these little apps that remind you to take your pills or little boxes where you put your pills. And all of these were sort of not working as well as you would expect. So these guys came with a super simple idea to package these pills for every day in a single small little package so you have a package for Monday morning, a package for Monday evening, for Tuesday morning. Tuesday evening. And it's such a simple idea. But it kind of transformed the way people were thinking about getting medication at least in the U.S. and this company's name was PillPack and it was I think probably a month or two ago was acquired by Amazon and they can feel it. Yeah for a billion dollars. So it's a very interesting story. If you were interested you should look it up from where they start up and where they are right now and their approach of looking at a problem and understanding the clinical need first and looking at things in different ways.

: Yeah you know and transformative doesn't necessarily have to mean complicated?

: Exactly. And a lot of people think that transformative always means complicated events. It's very easy to complicate but it is very hard to simplify and some ideas are simple but transformative.

: Gosh that is so great. What a great example and I love that you brought it back to today. John with this example of PillPack getting acquired by Amazon. It doesn't have to be that hard folks. It's just finding the right way to add value and so they obviously delivered value. They've been acquired. Great example there. Tell us about a story where maybe you know a company that you were working with Joao that didn't work and why that failed, a mistake. We learn more from those. I feel like...

: Definitely we spend a lot of time talking about successes and very little time talking about the failures. But going back to my time in Boston, well as during my Ph.D. there I got introduced to Healthcare hack-a-thons which are sort of became very popular right. And I work maybe two or three projects in this hack-a-thon's and they didn't work. They really failed miserably and I think this was very good. I was able to really learn and understand how a strong and validate clinical need is key to further startup idea in healthcare. And I was really not aware of these. I just wanted to work on maybe as a special technology that I was interested in and not really focusing on the clinical need. And interesting enough after failing a bunch of times trying to do these Healthcare hack-a-thons now with different ideas I ended up joining MIT Hacking medicine which is a MIT group that teaches innovation methodologies around the world. And I was able to travel all the way to Ecuador or Austria and I organize events there to stimulate the creation of new health care startups with a strong focus on finding validating medical needs. So in this way and looking back I'm very happy that I failed early on and learned from various foreign mentors.

: So that's so cool Joao. So the common theme with these three companies that they didn't work out was that there wasn't a clearly validated clinical need and then you spun around and MIT did clinical need based innovation hack-a-thons.

: Exactly.

: Love that.

: So I've quickly understood that the way I was approaching problems was that was not the best I was trying to work with a certain technology and find what can I use this technology for. And instead of starting with a clinical problem and then trusting that I would be able to find a solution in a team to that problem and that sort of change the way I was thinking about problem and technology trying to solve a problem and looking at the problem first before thinking about the technology.

: That's very cool. And while it seems pretty easy it's also difficult to stay focused on that because we tend to fall in love with technology, we tend to fall in love with the gadgets. So what advice would you give to people looking to work in this space looking to make a difference. You know like honestly make a difference. What advice would you give them so that they don't fall into these traps.

: Absolutely, absolutely. You're very right. I think working in multidisciplinary teams is key and then these hack-a-thons I was putting together teams that as a physician, an engineer, a scientist, maybe a lawyer, or a businessperson,a designer and all these people bring really a lot of different perspectives. So when you're stuck in the love with a certain technology maybe someone else is not. And they're able to show you a different way of looking at a problem. And in this way you don't get stuck. So I think that's a tip I would give to people working out in healthcare startups is have a diverse team.

: I think that's so valuable. So get your diverse team in place folks. You don't want to have people on your team with blinders or have them be too homogenous because it definitely could put your business model at risk. How about the other side of this Joao. Tell us about one of the proudest medical leadership experiences you've had to date?

: So I guess following all these failures I started learning and learning more about them and avoiding these in future projects and in 2017, I was a Innovation Fellow at the European Institute. And I had the chance to travel around Europe and talking and interviewing physicians and patients. It was really a great experience that allowed me to learn more about these unmet needs on a hands on approach just by going to hospitals and talking to, talking and observing decisions and throughout this process I was able to work in a team and find a novel solution for a problem which is colonoscopies we're really not doing a good job in tracking all apps that can lead to cancer when we do colonoscopies and because of these we have a very high rate of colorectal cancer. And throughout this experience of identifying first in medical need we're able at the end to go out with a new idea and started working on a prototype which say novel modality, medical device to address this issue.

: That's awesome man. So how long was your fellowship?

: It was for a full year was really a great experience because we were jumping from Budapest to Barcelona to Poland to a lot of different places and getting these inputs from many doctors in many hospitals where culture is different. The way of operating is different was really key to understanding what will be the most relevant need to solve first.

: Which is really cool. I mean I think it's really great that you had this fellowship tour and in general it seems to me like you're pretty jet setting kind of guy. You're not geographically bound by anything. Right.

: And he is very right there.

: You know you I'm from Boston now you're in Copenhagen so there's worldly perspective really matters. What were some of the common themes that you picked up you know you went from Mali to all these countries different healthcare centers, modes of operation, what were the common themes that you saw if you could highlight maybe one or two?

: Well I think first there's a lot of great people everywhere after being in Boston which is a center of excellence with great research I found that in Europe we can find the same thing so we can find really really good research and inequality that is at the same level. But then in terms of the way we treat patients I found really big differences between the US and Europe mostly in the way healthcare systems are efficient. So in US it seems that they're a bit less efficient. They do a lot more exams which cost a lot more money whereas in Europe, things work a little bit differently and there's more outcomes-based healthcare systems other than in US which is getting to that point.

: It's a really great great observation. And so folks from the providers side I know we're all doing a very very hard job or doing our best and in this transition to value-based care. I think taking on Joao's perspective you know he's been around the world. I think we ought to take a look at the folks across the pond in Europe to inform some of our decisions some of our pilots as we're adopting value based care. We have a lot to learn and I think our fellow Europeans could teach us some good things there. Tell us about an exciting project that you're working on today.

: Yes we're right now doing a podcast and I'm actually also working on on a podcast...

: Nice.

: Which is called the Futurelabs. And the idea behind this was that I really enjoy thinking about what the future might look like in different areas not just science and technology but other fields such as education or politics. And I started thinking about it and together with a friend we decided to start a podcast and started interviewing key opinion leaders about how they think the future might look like. And we're going to include topics as diverse as what's the future of Meet, the future of these therapeutics, and the future of open innovation. So I think that people are going to get excited with this I think.

: That is awesome man. Good for you. Now you have a name for the podcast then is it out yet.

: The podcast name is the Futurelabs is not out yet. We should be launching towards the end of October.

: That is amazing man. That's exciting. Good for you.

: Yeah thank you.

: We'll definitely do our part to share this project with the listeners because the reason why we started this Joao as you know is we wanted to make a forum where people could share best practices and connect with the people that are making a difference in healthcare. And so you're doing that. And so when you're done with that please let me know. We'll do a special episode on the release of your podcast so that we can get the listeners to check it out.

: Fantastic. That would be great. Thank you.

: Absolutely. Getting close to the end here John. Let's pretend that you and I are building a medical leadership course on what it takes to be successful in the business of healthcare. It's the one on one of Joao and so we're going to build a syllabus with a four question lightning round followed by a book that you recommend to the listeners, you ready?

: Yup.

: All right. Here we go. What's the best way to improve health care outcomes?

: Investing in deep science companies to innovation that reaches patients.

: What is the biggest mistake or pitfall to avoid?

: Not considering reimbursement.

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

: Embrace and lead change and pull yourself out of your comfort zone.

: Finally what's one area of focus that drives everything in your organization?

: We are very focused on finding and building extraordinary interest forming lifescience companies.

: Outstanding what book would you recommend to the listeners Joao?

: Well I think I would recommend maybe two. One that I read quite some time ago and the more recent one. The one I read a long time ago was called Creative Confidence from ideal founder David Kelley and it's basically about design thinking and it really changed the way I was thinking of our problems. So very very highly recommended. And the other one slightly different is called Shoe dog by the Nike founder Phil Knight. That's a very intimate story from like his early days and all the struggles that he faced. We know Nike right now has the bee corporation but it was not always like this. It's a very very interesting to understand how was Nike made and all the problems that they had in the beginning.

: Love that. Great recommendations Joao. Folks again we have Joao Ribas. And so what I want you to do is check out these resources that he just checked out. We'll include a link to his podcast when it goes live. But also the books and an entire transcript of our discussion just go to outcomesrocket.health/ribas as in Joao Ribas. You'll find all that there. This has been a blast, Joao, I love if you could just share a closing on with the listeners and then best place where they could get in touch with you.

: Sounds good. Well maybe I'll talk a little bit about what we do here in Novo Holdings we really invest with impact. So we are a very different VC compared to other more traditional VCs and the money that we make is then donated back to science and humanitarian purposes. So I just want to pass that message that you can make money at the same time impact society in this way.

: You guys are doing great things there. So where would the listeners get in touch with you or find out more?

: Sure you can go to our company website. So www.novoholdings.dk or you can also connect with me on LinkedIn or on Twitter @ribas.JC.

: Outstanding. Joao this has been a blast. Really appreciate the time that you spent with us today and truly excited to hear your new podcast then and also keeping up with the cool things that you have going on at Novo. Thanks again.

: Thank you.

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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How to Provide Value-Based Care with Arif Nazir, Chief Medical Officer at Signature Health

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How to Provide Value-Based Care with Arif Nazir, Chief Medical Officer at Signature Health

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 to the podcast. Today I have the outstanding Dr. Arif Nazir. He's a president at SHC Medical Partners. Dr. Nazir has established a career in internal medicine and geriatrics. He most recently provided medical leadership for the optimistic project an innovative CMS Innovation Center project to successfully decrease avoidable hospitalizations and improve quality of life of frail long stay nursing home residents. This is a key topic that a lot of institutions are looking to improve and he's headed this initiative in a big way. In 2015, recognizing his services to the state of Indiana. He was awarded the Tony Holeman Public Health Award in gerontology and geriatrics. He's board certified in a geriatrician and demonstrated experience in leading teams for improving post acute systems. He was most recently a speaker in our Health care Think A Ton conference and inspired the audience to be better leaders as well as practitioners so it's a great privilege to have you on the podcast here today Arif, thanks for joining us.

: No you're welcome. And the honor is mine. I'm really really looking forward to our discussion this evening.

: Thanks Arif. And so Dr. Nazir what is it that got you into the medical sector to begin with?

: Before I get into that I'm just going to add quickly is that I'm also in the role of our chief medical officer of Signature Healthcare which is one hundred and fifteen nursing homes across ten states. And the reason I wanted to mention that is above a lot of inspiration for the work I'm doing right now is coming from that.

: That is huge detail. Thank you for mentioning that. So one of the things that was really cool is sort of the way that you guys are approaching care at these facilities. I'm excited to share with the listeners some of what you shared during the meeting. So I'll open up that loop to discuss later but what is it that got you into the healthcare sector to begin with?

: Yes. So actually I'm a foreign to this country for the last 20 years before I moved here, I was living in Pakistan and that's where really I got my early on inspiration to enter the health field and when the time when I was going to fast for you to do well socially and financially you didn't have many options other than pursuing you know the field of engineering or the field of medicine and your parents felt obligated that they had to push you to work. Those are two things but personally I did get a lot of inspiration from positions. I remember feeling very inspired and motivated going to my local primary care practitioner who kind of weak authority and problem solving and poverty and from falling just for something which I was very attracted to you know at that age and got a lot of inspiration home from just me visiting my primary care practitioner and feeling that you know someday I will be also solving some key problems for my patients. And I got very inspired and made it a point that I want to pursue the field of medicine.

: That's wonderful and you did such a wonderful job of just making it a human thing. I feel like this connection and health care is something that is so important. So I really want to commend you for that talent and I think it's important in our practitioners today as it relates to addressing things on a broader scale Dr. Nazir, what would you say a hot topic that needs to be on every medical leaders agenda today? And how are you guys at Signature Health Care are addressing it?

: Yeah it's a great question. And I think for me the answer is quite obvious to our for the last 30 years or more, our healthcare system has somehow just been a victim of a fee for service structure where physicians were and practitioners in general were under the radar, in the doctor performance. I remember when I was training in my residency and even after that when I was working at the hospital and seeing patients nobody really asked me as a physician why are you seeing this question every day. What was the value and the benefits you brought to this patient from your visit? Why did you put out notes to them on this patient? What was different about you note today and yesterday? And I think that what value physicians bring to the healthcare system needs to be documented clearly and we need to challenge our self sufficient community and the practitioner community to prove that value and because and that the reason I say that is because you know we do bring a lot of value. And what I'm worried is that we just don't have good ways of measuring the value. And as a physician leader I feel a lot of pressure myself that I need to create structures for my own organization so that I can create a great story for some of my superstar physician and nurse practitioner that we're providing care and even nurses that I should be able to capture that clearly. So I think we all are kind of in this transition from fee for service to value bits are dealing with some of the metrics with the health care system or CMA setting up for us. But I think we need to go above and beyond the individual organizations because we need more strategies to really really understand what traditional professional and the nurse value is in the healthcare system. I think understanding value and number two thing which we have to be on top of is how our healthcare teams are doing in the frontline because again exposed to all the changes in health care, they are feeling pressure and they are burning out and they're not having as much fun. But we didn't have to pay attention how they're doing and the tagline, make their role as fun as it used to be for me when I was training many many years ago.

: So insightful and you know rather than respond to the wave, be the wave. And I think one of the you know Arif, the thing that you're doing that strikes me as really insightful is hey you know what value-based care is coming, it's here to stay. Why not work on communicating how you're adding value today? That's brilliant. I love that you're doing that. And so I'd love to dive deeper. Can you give us an example of how your organization has created results by doing and thinking differently because you do it so well?

: Yes I will give you that quickly. Two different perspectives on that. Nothing more for me is how patients are doing and getting impacted. So signature health care and SHC medical partner. We are absolutely taking the bull by the horns when it comes to innovation. And coming up with new ideas to care and just to give you an example of signature health care we are the largest organization in the country both good organization the country where our facilities are Eden Alternative certified which basically means that we believe in the new way of providing care to our residents so that if not an institution there. But it's really a home like our homestyled care that they're getting. And also for example we are the only organization who believe in doing yearly Senior Olympics and all of our residents get the opportunity to select their own theme song. There are uniforms and some cheering in the field to really participate in events to win medals and really really compete and show talent even though if they are living in a nursing home and you know nobody could have imagined doing any kind of thing that way they could afford to risk you know the residents would fall and if you talk to an attorney you know like people like know you can do that. And you can do that. And I think we have taken a lot of pride in doing things differently challenging the status quo. And I'm telling you that we have seen the benefit of it in terms of resident and for the patient engagement and quality of life around. We actually are involved in a very cool project with an organization called Time Slips. Time Slips is actually a company which is founded by MacArthur awardee doctor and Hastings where we are working with their team of professional artists to bring terror to the residents in our nursing homes as actors so they can participate in acting for some of their famous plays. For example currently 11 of our Kentucky nursing homes are working on Peter Pan as a place and they will be they will be showing their talents around you know performing in that. So we are seeing significant benefits of both approaches in terms of quality of life and collecting data and we'll soon be publishing that. So that's just one example from the residence side and from the physician side and practitioner side, we are working on a whole process of setting expectations and providing impacted works to our practitioners and physicians so that they understand what their value is and it motivates them to be better in what they do and also really understand what the value they brings into our studio to daycare.

: Man that's so inspiring and I love that that they're working on not only Olympic opportunities but also working on these plays in the arts and are just keeping them alive, keeping them going. A lot of organizations stop at that. No you can't do this from legal. What is your advice to a leader trying to make an impact and sort of that's facing these no answers from the typical responses from legal teams et cetera?

: Yeah I mean it's basically a cultural thing right. I mean our CEO has made it clear that we are going to be an organization that talks about how it can be done rather than why it can not be done right. I mean you can kind of come up with billion answers of why something cannot be done. And one way I will tell you that we have, we excel really well is that if we run into a block where we say "oh my god how can we do this? how can we do this?" We really really put our stock in our residents and our families. And I'll tell you that some of the neatest idea that we implement really come from the residents and the families themselves. So whenever you're stuck in a problem like this it's always good to go to a resident council or a family council and say hey we really were trying to do this? How would you feel about this? Would you become an advocate for us in regard to doing that? And that way you know you can for a lot of problems in a very very outside the box way.

: Outstanding great great piece of advice there. IAC you guys have created something beautiful something that's working well. You're starting to pull the data out of it to create the research to back it up. Can you give an example to the listeners of maybe a setback, something that happened while you were putting this together that you learned from that maybe you could help them?

: Well in thinking about in my current role I don't know if I can give you a stark example where I've failed. But I mean believe me there have been many instances where I've failed and I think the biggest shock that came to me in regard to me being a practitioner and a physician was how blind I was in regard to how different the perspective of patients and the families about the care I provide. So you know I, like many other physicians who are trained in the 1990's or early 2000's. I am a product of a very physician and healthcare centric system and I was really trained to be that it was all about me and what physicians sees in regards to disease and what are the best outcomes in the perspective of the physician that he or she should be working towards improving. But it was not really like a one day and I shared the story a few days ago. The meeting also was that when I went in to see a patient whose son was absolutely livid on the care that their father received and kind of told me that I don't care about your five star rating of your facility but let me tell you from my perspective the cure you provide is worse than my local restaurant. And you know initially I didn't understand what he was trying to tell me but it took me a few days to kind of get what he was telling me that patients have a very different perspective on what care is based on their own needs and if the customer is not getting satisfied that's it. You know you cannot defended by saying oh no the physician thinks that this is good for you and your blood pressure is way more important and really it's not about the pressures not about heart failure it's about how they feel in a healthcare system and the delivery of the health care is that meeting the needs are not which were more important and that's where I realized that how wrong I was that if not the outcomes that are really important to me which are going to define the quality of care I really have to have an ongoing sensor on when communication my vision of the family how they are feeling and let me tell you that a few days after this event happened a few years ago I kind of realized that there was a big patient acknowledgement board where patients would leave letters and cards for their thanks to the staff. And I realized that on the big board where we have dozens and dozens of great cards and thank you notes from patients there was not even once I was mentioned. They didn't even think about what the blood pressure medicine I gave them they don't really care about the heart that I treated. But you know who was mentioned on the board? It was a frontline healthcare team. The CMA, the health plans do you know the dietary person the housekeeping person who had given them what they really needed who had given them a hug and all those things then kind of really really validated that you know we have to see health outcomes from our patients who are really out to customers and kind of we have to have an idea on how health outcomes are and how we see them. What will be the big focus needs to be on how we are making the patients feel as a person. I think I was really really wrong and how were approaching healthcare onto 5, 6 years ago when I had an epiphany that I really have to be an advocate for person centered care and I think that really kind of started a new phase for me as a physician leader.

: Yeah it's so inspiring and folks when we were at the health care meeting. He and his team put together a video to demonstrate this point and I took it home I felt like that was such an effective way of doing it. But it was basically what a restaurant would look like if it was being served as a typical health care system would take care of their patients and it is definitely eye opening and you continue to do great things like this and this point I think we'll go a long way. And so tell us a little bit about a proud experience that you've had. You know you went to that learning about a proud experience that you've had today.

: Yeah I mean when I was practicing a full time clinician. I mean I still have a few patients but when I was reckoning of a full time job geatrician I would say that one thing which was really cool about my job was that I was having many many proud moments in any given day. As a geriatrician, you really really focused on a holistic patient care aspect and some of the simplest things makes you a hero in front of the family. And let me give you an example. You know it was quite a simple proud moment for me when I was sat down with a family and spend just ten minutes without any agenda and just to listen to them and their frustration with the healthcare system and then address simple things. Why are you taking this medication let's discontinue this medicine. And the smile that you see among the family members and the patients because they were like sick and tired of not understanding why are they taking all these extra medications why they had extra tests in the hospital and just sitting down and having the ability to listen to a patient for a few minutes and their family and understand their frustrations, really made them feel so much more satisfied. And there was nothing more proud to be able to do that. So I think nothing beats that kind of a proud feeling with you as a physician leader. I'm very proud to be a Chief Medical Officer of a very very innovative, very progressive health care organization, signature health care where I am working with the thief weighed in every given day of creating some innovative personal care models which are really needed for the future which are health care system.

: And no doubt you're doing some amazing things. And he had that listening. It said, "What can you do to listen to connect?" So take these notes from Dr. Nazir and think about how you can really fit them into the things that you're doing day to day. Arif tell us about an exciting project you're working on.

: So you know physician engagement is something which I'm really interested in particularly around the medical engagement. You know I'm a leader in postlude long term care side of healthcare and we have almost 16,000 skilled nursing facilities in the country. And every single facility is required to have a medical director. But here's an interesting thing, that we have as a healthcare system no idea what these medical doctors are doing on a given to a given day and if we have no way as a result we are not able to nurse them to do those things that will improve care that we really have no control or understanding what is going on in regards to the physician leaders performance in the facilities. And I've talked to hundreds and hundreds of physician medical leaders. We're quite frustrated sometimes because they have no real mandate to them is what they should be doing. So that's an issue which I think leads to a lot of dissatisfaction among our physicians and the folks who lost their sight. And I've been very passionate about this issue and wanted to solve this. So over the last two years I've been working on a digital application or a program to enhance medical doctor and physician engagement in government facilities. And the good news is that we have finally completed our pilot and now this application called CareAscend is available and is being implemented in dozens of nursing homes to really guide medical doctors and physician of what they should be doing as a part of the health care team and to be able to report in a life fashion what they are doing on a day to day basis, provide them outcomes of their facilities, and nudge them to be better at what they do so that that product has taken off well. And I'm really excited because I think it's a disruptive innovation which will change how physicians and physician leaders perform in their skilled nursing facility.

: Man that is so great. And you know it's wonderful that you put this together is CareAscend something that is only available to Signature Health cCre or is this something that can be used more broadly?

: Well the exciting news is that we already have external customers. Even though Signature is one of the stakeholders in it but Signature being one of the most innovative organizations was a long term care would never have the intention to really restrict the use of any innovative technology themselves. So you know we have a couple other healthcare systems that are implementing the program, the physician engagement program at this point as we speak. And the other exciting thing is that society of both the acute and long term care medicine is also supporting this approach and is also a partner in this approach.

: That is wonderful and is so great. And so folks if you want to check out some more about CareAscend or any of the work that Dr. Nazir's up to just go to outcomesrocket.health/signature as in signature health care and you'll find all of the show notes there along with links to the resources that have been discussed here. This is a ton of fun. We're getting close to the end here Arif. So what we'll do is we're going to build a medical leadership course, a syllabus on what it takes to be successful in health care, in value based healthcare. So this is the ABCs of Dr. Arif Nazir. We got four questions lightning round style fired by a book that you recommend the listeners you ready?

: This is exciting I'm ready.

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

: We have to empower our team as to be a better team and we need to know what value they bring to the table and what is resulting in negative hygiene and burnout.

: What is the biggest mistake or pitfall to avoid?

: I really would like to quote Tim Cook here the CEO of Apple. Now that he says that my fear is not that machines will start thinking about humans. My fear is that humans will start thinking like machines and I think we really need to understand where technology is really suited and needed and we can not trust technology everywhere without understanding how the team is doing what they need to do and then adding technology on top of that.

: Wow. That's insightful. How do you stay relevant as an organization despite constant change?

: You have to spend 30% of your time thinking about the future and investing your time and resources in building ideas, products that will keep you relevant for the future and there's just no other way around it.

: What's one area of focus that drives everything in your organization?

: Person-centered outcome. We want to be the best from person and patient perspective and everything else is secondary.

: Love that. What book would you recommend to the listeners as part of the syllabus Arif?

: Well until now I have had a favorite book. It's called Drive: The Surprising Truth About What Motivates Us from Daniel Pink.

: Yes.

: Which currently changed my mind and my attitude to worse behavior change. So I highly recommend that and the one which I'm becoming a huge fan of as I'm reading it. It's from Yuval Noah Harari is the book called 21 Lessons for The 21st Century.

: Love that. Two great recommendations, a syllabus, all available to you at outcomesrocket.health/signature. Arif this has been a ton of fun I really have enjoyed our time together. I love if you could just share a closing thought with our listeners and then the best place for they could engage with you or reach out.

: Well my closing thought would be that we just need to challenge all the status quo and we just need to make sure that we all understand why we do what we do. Life is short, time is limited and we should not be investing our energies in any initiative until we really believe that it's going to lead to some gain in the mission you are living for. So be very thoughtful in that and do a reflection more frequent. You know very frequently on that aspect and in regards to how to get hold of me. It is very easy. It's my email which I'm sure will be available I answer almost all my emails within a day or two but very easy to get hold of me.

: Outstanding. I'm always inspired when we when we talk. Dr. Nazir. So keep doing your amazing work and just don't stop inspiring others to follow your steps. Again just want to say thank you for spending time with us, has been a lot of fun.

: Well the pleasure has been mine. Those have been really really exciting. Thank you so much for having me on the show.

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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Using Real World Evidence to Accelerate Development and Impact of Treatments with Jeremy Rassen, Co-Founder, President and Chief Scientific Officer at Aetion, Inc.

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Using Real World Evidence to Accelerate Development and Impact of Treatments with Jeremy Rassen, Co-Founder, President and Chief Scientific Officer at Aetion, Inc.

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

: And welcome back. It's a pleasure to have you all back on the podcast today. I have Jeremy Rassen. He's a Co-Founder, President and Chief Scientific Officer at Aetion. Jeremy is an Epidemiologist and Computer Scientist with 20 years of experience in the Science and Technology of Big Data. It's this awesome combination that helped them put together the resources and plan for the work that they do there. He was an Assistant Professor of Medicine at Harvard Medical School where he developed cutting edge methods for developing quality evidence using real world data. Prior to that Jeremy spent a decade in Silicon Valley. He was the fifth employee at Epiphany Incorporated where he was involved in the creation sale and deployment of data intensive applications for marketing and customer relationship management. There's no doubt that the shift that we're having in health care is going away from the typical Hey devices life sciences approach. It's all about what you could do with data to improve outcomes and so it's such a pleasure to have Jeremy on the podcast today to share his insights in this space. Welcome.

: Thank you.

: It's a pleasure to have you Jeremy. Anything that I left out in that intro that you want to share with the listeners?

: No I think that was pretty comprehensive.

: Awesome. Well listen there's no doubt that paths lead into health care and a lot of different reasons a lot of different ways. But what was the way that you got that into health care?

: You know I think in your intro you almost had it as you mentioned at the beginning of my career I spent about 10 years on Silicon Valley working on big data applications I was computer science undergrad went back to where I'm from which is a San Francisco area after school and got engaged in all the tech that was going on there in the mid to late 90's and really adored the technology, I really enjoyed the technology of using data sets to find these interesting associations to find even interesting causal facts. I wanted to apply that in a way that was different than what I was doing out there which was large as you said in marketing and customer relationship management. So transitioned to health care and my first step there was getting a doctorate in Epidemiology at the Harvard School of Public Health. And if you think about public health my parents I grew up in San Francisco they said their father is an internist in San Francisco. My mother ran a large social service organization. So if you average out the two you kind of get public health. So going to school, public health and getting degree in epidemiology felt like a return home in memories but also return home in the sense of being able to take the kind of questions you were asking of the data and apply them to a whole new field that is to say effectiveness safety and value of medications.

: I think it's so fascinating Jeremy and it's really interesting how you sort of dovetailed all that into the public health and and with your background in Computer Science. I think now is the time and everybody is talking about value-based care. What do you do? How do you do it? What does it mean? And so I love that you and your team are are working to quantify and really find a way to scale these things that are essential to our business and for our patients.

: You don't have to say that was one of the first things I've worked on in Boston and identifying named Sebastian. Sebastian had spent the prior 10, 15, 20 years thinking about how to use the data sets that came to be as part of the running of the health care system claims medical records and other data to really evaluate safety effectiveness and value in particular out of medications. And he'd been thinking about that in a very structured epidemiologic academic way. I've been thinking a lot about data and really from that from the first moment we put our hands together and said how can we take that really strong causal thinking that's developed in the field of epidemiology and put that to work at scale which is the big part of it. Put that to work at scale for answering these questions of value that we all have.

: Super interesting. So you're taking a look at this data and you're trying to figure out how to make the best impact and health care. What would you say today is the big hot topic that needs to be on all the health leaders agendas today and how are you guys at Aetion addressing it?

: It comes back to value for me. I think the inside the healthcare field at this point and talking to friends and colleagues who are outside the health care field gets pretty clear that the rising costs aren't good for patients they aren't good for the health care system and you know ultimately they have to be unsustainable. So thinking about how to spend money in a way that improves patient outcomes it also sustains the system. As a hot topic in our wrap up and call that call it value.

: It's really important to look at this and some curious how are you guys looking at value and how are you helping health systems look and measure value. I think this is a thing that a lot of people struggle with.

: Yeah we really look at values starting with decision. There's a thousand decisions made. You know every moment in health care as a scientist I have to be careful with numbers but a lot of decisions being made. Every moment in health care and those can be small decisions at a clinical and for one patient large decisions happening at payers or for pharma companies or other places affecting many many patients and I think the vast majority of the decisions are being made today or done either with intuition rather than evidence or with evidence that isn't really pertinent to the patients and that decision will affect. And so I think a lot of what we do is intuitive. We have the data and now, we have the information now to do this based on evidence to make these decisions based on evidence and not just any evidence. I think there's a lot of evidence out there. Our's a randomized trial year. That's a very high quality but doesn't necessarily describe the patients that we're treating at any given moment. It could be that the trial was done in a particular part of the country or in particular patients subsegment with a particular set of comorbidities. We need evidence that supports decision making for all patients and for patients in particular who were treating in any given moment.

: So Jeremy that's really interesting and I think it's important that we start looking at that I mean I think of let's keep it simple right like cable. If your cable company doesn't deliver what you believe is a good internet speed. Guess what you're going to cut them out in the same way as kind of happening here in health care. You know rising health care premiums have got rising co pays. So now you go to your grocery store and you've got this like Smart MRI place. Now they're actually giving you options. You're going to pay less for it. Value is something that we need to deliver. Can you give the listeners an example of how your company has helped organizations create results through this value perspective?

: You know absolutely and you know I'm thinking about the MRI exam.

: Yeah.

: That might be incredibly important for the treatment. One group of patients but much less important and perhaps even an important to remain powerful for another group of patients. There is certainly a cost of a certain kind of cost for patients with her procedure that he or she doesn't need. So that's in some ways the context that I think about value in. And so you know one example that we've engaged with here at Aetion is working with a pair here in the Northeast where they had a pretty general question and that question was, helped us better care for our diabetes population. Diabetes population at this pair large and growing and growing in terms of the disease itself the diabetes itself but also all that comorbidities that go along with diabetes and all the utilization and cost that ensue from the diabetes and comorbidities. And so those were the pretty big question. Now help us better manage her diabetes population and for us managing rather answering a question like that starts with really understanding who the patients are. Who is this population? And so to do that you want to break down the population using the data for the pair because that's representing ultimately the patients that they're caring for not national data not a randomized trial that 70 Ram payers data and really digging into those data to understand who the patients are? What kind of treatments they're currently experiencing? What kind of outcomes occur and how we could possibly change those outcomes or some or all patients? So with this particular payer we help them break down their diabetes population and show that it really wasn't monolithic in any way. They certainly knew that but described the ways in which it wasn't monolithic and in particular there was about 10% of the diabetes patients who were particularly severe particularly high risk and high risk both of a progression of diabetes but also these comorbidities type which I mentioned before. So as I said that's 10%. That's a relatively small number. But those 10% were being treated to guidelines and the way the other 90% work. And the guidelines say you start with the first line therapy that doesn't work. You move on to kind of something in the middle between first and second continue with second line therapy. And what we showed was having identified these 10% of patients if they're treated directly with the second line therapies which are more expensive they cost more but that cost is over the ensuing months represented much better outcomes for the patient and much fewer E.R. visits and hospitalizations, another kind of high cost services for the payer. So that's not everybody, that's one in ten. But if you think about how to treat the one in ten differently than the nine in ten, you end up with amazing results both for the patient and for the system itself.

: So yeah that's really neat Jeremy. And the interesting part. You know a lot like it's sort of a microcosm of the health care environment that we're in. Most of the spend goes the 5% of the issues that are out there. And the nice thing that your company is providing sounds like you're giving these people not a representation of the U.S. but a true analysis of their population.

: Absolutely. Every entity within health care has a certain group patients for whom they were responsible. A payer population, health systems, patients that they're treating. In this as you can get closer and closer to really looking at how to improve outcomes within that specific population under treatment, I think we can do better and better.

: Yeah and a lot of times we think of value-based care. Your mind and you know through conversations you typically go to like. All right. What value are you providing patients? And I think another way we should be thinking about it Jeremy and appreciate you for taking this up is what value are you providing to providers and helping them identify the best treatment for patients. As a payer for instance you're collaborating with the other stakeholders in health care. Value-based care is all about collaboration between all the stakeholders.

: Absolutely. And we see that as a very core part of what we do which is to help bring these stakeholders together on a shared and transparent and well understood evidence base that's pertinent to the patients being treated pertinent to the population is being cared for and to do that we need. Good data.

: And you know over the last 20 years I would say there's been a huge advance in a methodological basis for real world data analysis to real world evidence and say in 20 years that we are looking at randomized trials as not just a gold standard perhaps the only way of really getting at these important questions of just drug A work better for drug B among patients with very severe diabetes and substantial comorbidities. A randomized trial 20 years ago may have been seen as the only way to answer a question like that. Today we have the epidemiologic basis and scientists are sorry for going into the...

: That's all good.

: In methodologic basis for really doing that either with a randomized trial or with the data that's already generated as part of the health care system the real world data and I think that's the extraordinary evolution over the last 20 years that really gives us the opportunity to measure value and deliver value in real time. And for the patients who were being treated as I mentioned and I think that's extraordinary evolution of the last 20 years in our company Aetion in the software that we create as a platform for taking all of those developments over the last 20 years and putting them into software that can be deployed quickly and at the right points in the health care system to make these really important decisions that everybody through the system needs to make to make those decisions fully evidence-based at the highest level of quality.

: Love that love that sounds like it's a phenomenal tool. Folks if you haven't had a chance check out Jeremy's team and all the things that they're doing at aetion.com. You'll find all the software solutions they offer there as well as the team of outstanding contributors that they work with there. So things don't always work out Jeremy sometimes we hit brick walls especially in entrepreneurship and health care. So we learn more from those moments. So I want to ask you. Give us an example of a time when you had a setback and what you learned from that setback?

: Yeah I mean so we founded the company, Sebastian Schneeweiss, and I about five years ago and that's give us ample opportunity to as we go along. I'll say that there are a lot of things that that you know really came together over those first years and one of the first things that Sebastian did was to go and find just top top top down tech team to build out this software platform and we need to be able to do this fast and be able to do this scale. We need to do this on time. These are all things that you really need a top tech team to create. I think at the beginning of the outset, at the beginning we thought that our customers would have all the questions available and ready to go. And just you know we're needing software to input all those questions into you get the answers and what we learned over the ensuing years was that sometimes in fact even a lot of the time those questions were available but sometimes the questions were broader like I'm launching a new drug and I want to get ahead of any potential concerns that FDA might have about safety. How do I develop an evidentiary base around the safety of my medication or even something that was even a little broader like helped me understand my diabetes population. And so I think one of the things we've learned over the years is that the software and our interactions with our customers have to really start with all levels of questions and that we can really as an organization engage in these issues. And at any place in our customers thinking and that is something that we really learned over the last couple of years.

: And you know it's interesting because you often think like "hey you know we dive into some of these challenges that our customers have. And you imagine that the questions are already there but oftentimes as somebody coming in from the outside that's where we could offer the most value." Right. Just like seeing it from the outside and helping them formulate those questions.

: Yeah that's really interesting. You know I think coming from the outside or even coming from you know kind of just from the outside just outside right.

: Yeah.

: You can see a little bit how a pattern of thinking can lead to a series of specific questions and that's something that we can really help our customers with and something that we do you know at this point.

: I think that's so cool. You know one of the things that happens a lot with me Jeremy is kind of like a long long lines what you just discussed is you know I interview a lot of awesome folks like yourself doing outstanding things in health care. Now reach out to me and just say hey you know what are you saying and just kind of being off on that not even I outside like let's just call it sidelines right. You're still very involved. You could really help clients have that unique perspective that they need to make those breakthroughs.

: Yeah I mean the answering these millions have problems in health care. You know how do we find optimal value for patients in the system? How do we you know really get these underlying questions involves first with exactly that stating the right question. And you know I was reading a book by Judea Pearl which I highly recommended called The Book of Why, where Dr. Pearl is a one of the true pioneers in causal thinking.

: Okay.

: Helping to break down the problem and express it in a way that is truly causal. Meaning not just if I switch a drug A versus B which is going to be better for patient BUT really identifying which patients you're talking about and what that switch will mean and really can what the alternative would be to treating with standard of care and that kind of causal thinking is really needed because at the end of it if you're talking about a decision that's going to change health care or change health outcomes or improve outcomes for patients, you need to be thinking causally. You need to be thinking about "What can I change that's really going to make an impact on the patient or on the system?" So framing questions in a causal way is something that I as epidemiologist think about as a really important first step in this book by Pearl, I think talks very nicely about how to think about questions of framed causally.

: Love that. What a great recommendation there one that I'll definitely add to the list Jeremy thank you for that. Let's look at the other side of this this question right. You took us to sort of a set back and what you learned from that which is super valuable. How about one of your proudest medical leadership experiences that you've had to date?

: Well you know just as five years has given us quite a bit of time to experience the first part of that we've also had I would say a number of really proud experiences our company has as mentioned is five years old started with three people in a little office here in New York City. And we've grown now to mull over 100 where you're in York City up in Boston on the west coast and all over the country.

: Amazing. Congratulations.

: Thank you. And really the company has grown and as the company has grown the needs of the company have changed quite a bit. So one of my personal proudest moments was working to recruit Carolyn Magill, she's our CEO. She joined us a little more than a year ago and she had just this phenomenal experience growing startups and working in the payer sector and really just a deep deep understanding over her years experience of how the health care system works and the dynamics of the system. And that really complemented an important way how we've been thinking about decision making and causality and the science and the software to support all of those questions and decisions. And so you know thinking about promised the leadership experiences. I think bringing Carolyn to our organization and being part of that is something that I'm deeply proud of and has been you know incredibly successful push for our organization as well.

: That's awesome. Well Carolyn shout out to you and Jeremy nice work on recruiting her. It's tough to get the right team put together. I'm a firm believer of hire quickly but fire slow. Well it's actually the other way around right. Fire quickly hire slowly because it's hard to find the right people.

: It really is. And one of the things I really enjoy my organization is how deeply engaged in the thought that's required to really bring powerful solutions to the health care field and that's something that at all levels from literally all levels of their organization leadership there should be really thoughtfully engaging at all times and Carolyn and the leadership team that she's assembled as and she joined a little more than a year ago. I think really represents at where we are for it.

: That's awesome. Congratulations. So Jeremy tell me about an exciting project or focus that you're working on today.

: Well we talked a little bit about randomized controlled trials, RCT's and talked a little bit about real-world data. And so the sister concept abroad evidence that the DNRWE to use the lingo. For me one of the most exciting projects working on is looking at how the methodological developments over the last 20 years that I mentioned, real data in real-wprld evidence have gained ability to really support causal decision making whereas in randomized trials were kind of the big game in town perhaps the only game 20 years back. I think one of the most exciting projects we're working on is looking at how real-world data can support a regulatory decision-making. So we were selected by FDA working in conjunction with Brigham and Women's Hospital and Harvard Medical School in Boston to kind of replay history a little bit to take 30 trials that the FDA had used for decision making said 23 leading to a positive decision and seven into a negative decision and to replay history and to see if we can use real-world data. The data, it's part of the health care system data that's available at the same time that those trials were being run with real world data analysis have led to the same decision that the randomized trial ultimately led to randomized trials. As I mentioned a gold standard in causal thinking and also very expensive limited to small patients, limited to very likely among representative group of patients, older patients, patients with extensive comorbidities, lastly under represented broadly speaking in randomized trials. Could we come to the same conclusion using old data. So that's a project that's on going...

: Fascinating.

: With FDA and we're also working with regulators around the world on some more kinds of projects. And to me this lets us get to the place of really applying real-world data and all the instances where we can apply it and I want to be clear that's not every instance not every question answered by a randomized trial could potentially be answered with real-world data but in those instances where we could make that switch, let's have the evidentiary base for making that switch and let's do it because that lets us get at really key really important answers all that much faster at much lower cost. Again sort of this idea of value and the health care system and really lets us affect positive outcomes for patients as quickly as we can.

: I love your conviction Jeremy and it sounds like there's some really great groundwork happening here. It's even, take a look at causal versus randomized controls methods to do things within our space. I think that's a very important work that you guys are up to.

: And as a scientist I'll say it's thrilling work. I, it's truly thrilling work as well which is awesome.

: Fantastic. And the cool part about it all is that on the back end of it this thrilling work actually impacts patient lives and there's nothing more thrilling than that.

: Undoubtedly so and being able to do that at scale I mean being able to put it into stuff that really leads to that quality decision making and health care system access to place it's really really thinking very carefully about high quality patient outcomes and value.

: That's awesome. I totally agree with you. And we're getting close to the end here Jeremy this is the final part of the podcast. You and I are going to build a medical leadership course and what it takes to be successful in the business of health care. It's a one to one of Dr. Jeremy Rassen. And so we're going to write out a syllabus. I've got four questions lightning round now for you followed by a book that you recommend to the listeners. You ready?

: I am ready.

: Okay here we go. What's the best way to improve health care outcomes?

: So for me this course is about data-driven decision making and health care and for need and the best way to improve health care outcomes is to start by really really carefully measuring and understand health care outcomes. I think only by measuring and understanding health care outcomes can we really improve them and really prove that we have improved them.

: And is that second part that I feel like is often missed. It's like sure measure them but understand them. I love that you just throw in the understands there because it really takes it to that next level that you really need to improve outcomes.

: And you know somewhere in the you know later later courses here , the later lectures of our course. I think you get a lecture on applying what you learn and really looking to take what you learned and turn it back into that next cycle.

: Love that. So what's the biggest mistake or pitfall to avoid?

: So I think through our conversation we talk a lot about causality. For me the biggest mistake to avoid is to confuse an association that we see in health care with something that's causal something that if you made a change it would truly affect that patient. You see it over and over and over again. And to me that's the biggest mistake and also perhaps the most probable mistake.

: How do you stay relevant despite constant change?

: As an organization, you know ultimately we're answering questions alongside our customers that improve health for patients and so you know relevance in that case is making sure that we're thinking about the questions and have methodologies ready to answer the questions that most relevant for patients. As time goes from today to tomorrow to many many years from now.

: What's one area of focus that drives everything in your organization?

: It's the seriousness of our mission. I think every single one of my colleagues here understands that the insights that we're unlocking are ultimately about patient health and that requires real seriousness of mission and of purpose. And I think I tried everything to do.

: Beautiful. And what would you recommend as part of the syllabus Jeremy?

: Well I guess part of the syllabus I've to say The Book of Why by Judea Pearl, which we talked...

: Talked about it earlier. Yup.

: If you ask me what book in general would I recommended maybe it's hard to look...

: Let's hear the extracurricular read listeners.

: The extracurricular read let's say I've just been really really enjoying the Trevor Noah audiobook, Born A Crime. I know this is in podcasts circles because I shouldn't say that this was one of my first audio book spoken word iPhone.

: Hey you took the jump though and that's what matters.

: It's linked the spoken word experiences. And I just thoroughly enjoyed it. His perspective is fascinating just the way he tells the story as he reads his own story. It's just phenomenal. "I couldn't recommend it more.

: Outstanding. There you have it listeners, check out all the things that we discuss. The transcript, links to those books, links to Aetion, just go to outcomesrocket.health/aetion and the website for Aetion is aetion.com. So make sure you check that out. Everything is right there for you easy to access. Jeremy this has been fun. I really have enjoyed our conversation.

: Likewise.

: Before we conclude I love if you could just share a closing thought. And then the best place where the listeners could get in touch with or follow you.

: Well the best place for listeners to follow us is a Linkedin or Twitter or pretty much either. Closing thought, it goes back to the beginning. Ultimately as a field, we need to be thinking very deeply about value. And as we think deeply about value we you make really important decisions for the patients were entrusted, to care for. And so for me those decisions need based on quality evidence, that's pertinent, that's there, that's timely, and that's how we best serve.

: Outstanding Jeremy. Now for sure you guys are leading the way in a very important way. So keep up the awesome work one of the things that I think about Jeremy when I just kind of think about the lessons that you've shared is that we tend to overestimate what we could do in one year but severely underestimate what we could do in two or three decades. And I think the impact of that it's going to be huge. It's going to be huge. I love what you guys are doing so keep up your amazing work. Thanks for carving out time for us today.

: Thank you so much for the opportunity. We're, we appreciate it.

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

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How Anthropology Can Help Improve Health Outcomes with Abner Mason, Founder and CEO at ConsejoSano

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How Anthropology Can Help Improve Health Outcomes with Abner Mason, Founder and CEO at ConsejoSano

: Welcome back to the show. And today I have an outstanding guest. His name is Abner Mason. He's the Founder and CEO at ConsejoSano, the only patient engagement and care navigation solution designed to help clients activate their multicultural patient populations to better engage with the health care system. As you all know this population health care approach is so important especially as the demographics of our country change. ConsejoSano's clients are typically health plans and provider groups serving Medicaid and Medicare Advantage members and patient populations. So the work that Abner's doing is fascinating. Currently he's the CEO there but previously he served as Founder and CEO of the Workplace Wellness Council of Mexico. They provide members companies with access to cutting edge workplace wellness programs and a form of best practices. He's done a lot. He was appointed by US President George Bush to the Presidential Advisory Council on HIV and AIDS. He's done a lot of things with other states as well. So it's a pleasure to welcome Abner to the podcast to hear his story and the work that they do at ConsejoSano. Abner, welcome.

: Thanks, thanks I'm glad to be here.

: It's a pleasure to have you my friend. So did I miss anything in your bio that you want to share with the listeners?

: Not only that I did do a stint in state government so I have had the experience of working on the government side which has its own unique challenges. So I always like to remind people that I have done my duty on the government side.

: Hey man that's important right. Because a big part of the payer is government.

: Yep yep yep. Chief policy adviser for two governors of Massachusetts and also worked in a couple of agencies in state government so I know I've got a feel for the cadence of state government and government in general and state governors in particular and the cadence is slow so I'm having I'm on the other side and I'm trying to frequently work with governments experiencing it. Realize just how slow government business one of the things we need change.

: Love it man I love it. Totally agree with that. So what would you say is the reason you got into the medical sector? What got you in man?

: I was a bit of an accident. I was a Chief Policy Adviser for the governor of Massachusetts and my background had really been in transportation. I had been deputy secretary of transportation from Massachusetts and deputy A.G. for the transit authority in Massachusetts so I had a lot of experience on the transit side and then I started to work on the highway side as well. But then the governor asked me to come to the governor's office to be Chief Policy Adviser. And in that role I had to learn about other parts of government beyond transportation including education the environment. All the other sectors of government at around that time I was asked to join the Advisory Council on HIV and AIDS. And that's really what got me into health care because when I joined the advisory council in HIV and AIDS I realize the challenges that HIV posed both domestically and internationally. They were good enough to appoint me chairman of the International subcommittee. So I was responsible for helping develop recommendations for the president, the secretary of state, and secure health and what the U.S. should do with respect to AIDS globally. And that just opened my eyes to the importance of health care but also to the importance of tackling big challenges and health care. And I learned a lot and then experience so that led me down the path of doing more and more in health care.

: Man what a winding path. But you know what. It's oftentimes when you get thrown into these situations that you're forced to grow and then you all of a sudden like when you least expect it you just sort of find your love for health care and I think it's so cool that you happen upon it like this.

: Yeah it was not you know a plan that's for sure a winding road here. But once I sort of dug into health care it's a fascinating area as you know it's got amazing challenges but you can really at the end of the day know that if you are effective you're really improving people's lives. So that's a great incentive.

: I agree completely so improving people's lives is key and I think a reason why a lot of people stay despite the challenges in health care. What would you say Abner is a hot topic that needs to be on every medical leaders agenda and how are you and your team at ConsejoSano addressing this?

: Obviously I'm preface this by saying I'm biased. What I think is a hot topic and certainly what we focus on here is trying to make sure that we can find ways to connect health care to what is becoming the majority of Americans so let me take a step back and explain and share my thinking on that. The country has changed demographically quite dramatically over the last few decades and we're on our way to becoming a majorit, minority country according to the U.S. Census will reach that status as a country in 2050. Majority minority.

: So how do you define that? What is that? What does that mean?

: So that means that basically if you add up the groups that are non-traditional white American yes you add up the populations of those groups they constitute the majority.

: Okay got it.

: Take Hispanics and African-Americans and Asians and Arabics folks and add them of all of those. What we would traditionally call minority groups broadly speaking if you add them up they will constitute a majority. That's a dramatic demographic change that has occurred and is occurring over the last you know three four decades. So according to the census the whole country will be majority minority by 2050. Some states you know like where I am in California we are already a majority minority state. If you take Hispanics who are 40% of the population here and add to that Chinese and African Americans and the other minority groups those groups compose a majority in California today the same thing is true in Texas today. Texas is the majority minority state. So this is a huge demographic change.

: Yeah.

: And it is a change that let's face it it's not easy. If you look at rest of our national politics today a lot of what you hear and see and read in our national politics reflects the struggle to accept this demographic change it's hard and it has created a lot of stresses in certain sectors of the economy and of society. I think that when health care for those of us who are in health care we have to accept that this change has happened. This is the America that we have become and it's the America that we are continuing to become. The idea that we can reverse this, it's just not possible.

: Right.

: So people in health care have to accept that we are a very multicultural country and becoming more so. That's the first thing we have to accept. And then the second thing is that health care in America has not kept up at all with that demographic change. Our health care system is just not equipped to serve the America that we have become and that needs to change. Like in California I'll give you. Credit is the Caligula's 40 % Hispanic right...

: Yup

: Only 5% of doctors speak Spanish speaking Spanish is not even go here because what really is important is not just speaking the language but it's understanding the culture so that we can engage with these patients. So just to answer your question the big challenge here is how do we begin to make the changes so that our health care system can engage with. Because if you don't engage with people you're not going to get good health outcomes if you can't get people to trust you, to come in for appointments, to tell you the truth when they come in, you've got to get you've got to reach out to them, you've got to get them to come in, and you got to get them to tell you the truth, you've got to get them to engage in a dialogue with you as a healthcare provider of health care system you know writ large. We've got to engage with people and we don't really get terrible outcomes and that's what's happening now. And I think it will get worse if we don't begin to figure out ways to engage with the people that the health care system has to serve and that engagement is not about language it's about culture is about connecting with people is, who they are, understanding who they are, and building trust, and hopefully over time that trust leads to a level of engagements that people say "Okay I'm going to listen to you. I'm going to come in. I'm going to have a relationship with a primary for example a primary care provider. I'm going to listen to my primary care provider. I'm going to start to think about my health in a more holistic way". So all of these things are important for us going forward and I think that if we don't start to get some of that right a lot of the other good things we're doing in health care are not going to bear fruit because we won't have the engagement that we need. That's some of the fundamental requirement.

: Abner, I think this is very insightful and I like what you've done here. Typically we find ourselves stuck not necessarily stuck but reflecting on things that matter in health care. But you've taken a step back and you've forced us like the listeners me to not just think about health care but reflect on the population of the U.S. and take a look at it and how that affects health care. So looking from the outside in folks it's so important that we don't get stuck in the trenches like we do. I mean we do that we were guilty of it. Nothing wrong with it but let's step back and start looking at the changes of the demographics that are happening in this country and that's why today with the discussion we're having with Abner this will be great way to sort of get you to start thinking about what you're going to do differently to best adapt to these changes seek a better serve your communities. You could better serve your patients so give us an example Abner of how you and your organization have created results by doing things differently.

: Sure. So one of the things we realized pretty early is that to get engagement we were going to have to do things differently to get engagement with these multicultural populations who aren't engaged. So we look to see what what's happening now and it's not as though health care providers across the country stakeholders you know plans and provider groups. It's not as though they don't know that these demographic change is happening. And so many of them have taken a step to start to address that. And what we call it is of multicultural patient engagement 1.0. Right. So and what that is is it's translation. Basically health care providers across the country if you wherever you go. Basically what they do is they take content that was designed and written for a more traditional sort of English speaking American who grew up in the English speaking environment. They take content written for that person and they translate it into other languages. And that 1.0 version doesn't work for a couple reasons one to engage people you've got to connect with them, you've got to figure out a way to build a bridge to them to connect with them, and when you send content that was written for a person A whose life experience who's in who's understanding of health care who has experience with health care who's experience with you know life in America is completely different, completely different from person B. But you send a message intended for person to person B you just sort of translate it sometimes poorly using like a you know some sort of google translate. You get really bad results and you don't get engagement...

: And you gain the last connection right?

: Exactly.

: Arguably.

: You really raise a good point. So even though it's well intended sometimes because plans are you know in provider groups and they're trying to reach out sometimes it's not that well intended. They're just checking the box it's just a regulatory requirement alerting a lot of places of America in order to comply with the law. You have to offer your services in these languages. So to check the box they just hard translate checking the box so really there isn't a real intent to connect with these people. They're just checking a regulatory box. But even sometimes there is a good intent, they're trying. But here's what happens if you've ever been a member of a minority group and you've been treated equally or you have been made to feel invisible or you've been made to feel like who you are really doesn't matter. And sometimes you've just been outright discriminated against. It's ever been in that it's in a person who belongs to a group and experience that what happens over time is you develop a very clean awareness of when people are being sincere and reaching out to you because they really want to know who you are. They really want to connect with you and they really value you as a person versus checking the box. It's like this antenna that these folks have and even if it's well intended if you send a check the box message that's really a content written for someone else that you're just checking the box. It can have a negative effect. It's actually worse than doing nothing because what it says to the person receiving it is you really don't care who I am. You really don't care to learn about me. You're making no effort whatsoever to connect with me and what that does is it builds distrust. It can also make people not like you very much but if you treat people that way like they don't matter who they are is not important. It's no wonder they don't want that kind of engage with you. So I think we've got to get away from that 1.0 version of engagement. And so what we are suggesting a consensus on what we're doing is what we call 2.0 we're saying we've got to take it to the next level and that is we don't think translation works. You have to start instead with culture. We have to figure out who these people are and what they care about, what they believe, what they hope for, what they fear, where they live, where they come from, what their experiences are in daily life. Trying to get a better feel for the whole person who they are. And we call that culture to...

: Yes

: And that encapsulates all of it which I don't understand who people are culturally so we start there then we design content based on the culture. So we don't design content you know we don't send a message to an Arabic speaker a young Arabic mom. She may be low made Medicaid. We don't send the message to her that the same message we would send to English speaking mom of the same age who has wound up in the U.S. culture. Not only is the language different but the content itself is different because of the way that Arabic understands life in America or what she experiences the way she understands healthcare the way her culture has weaved in and understanding of health care with the American experience it's even unique it's not even as though it's the same as if she lived in her home country. There's a wonderful I think kind of thing that happens when these cultures hit American culture and the third new thing gets created. So we're trying to connect with people on that level. So it's first of that culture then we design the content then we layer in the language so see language from and our view is language is a tool. It's not. It doesn't tell you anything about what you should communicate. It's a tool to communicate. Yes though language is actually the third thing it's not even the most important thing. Its first culture then content then language. And then the fourth thing that's really important is mode of communication. Health care in America is still stuck in the 30 years ago today and guarantee it's true for human beings.

: So you mean you should have faxed these people?

: Exactly. I mean it's craving that is. When they 18 right and you can't send a text message to the everybody communicates via text message. Everyone in America this is the way we communicate now. And yet in health care we can't do that. I was at a conference two weeks ago yeah. Held in San Diego it was a conference of Regional Health Plans. There were 27 plans across the country. These are pretty large health plans, regional plans across the country twenty seven. I was giving a talk I said "how many of you primarily communicate via text message with your family and your friends?" Everyone raised their hands. "How many of you communicate with your members who are in population health management or chronic disease management or just general engagement?" Not one hand went up.

: Yeah.

: Not one. This is 2018. It's as though...

: Not even one?

: Not one you know I jokingly say you guys may as well be using morse code numbers because snail mail and e-mail and I mean they're stuck in these old modalities engagement. That's not the way people communicate today. So I'll stop there. But it gives you a sense of how we are trying to change the way we approach engagement and what we're getting is incredible result because it turns out when you respect people enough to connect with them it's who they are and treat them like they actually have value as a person. They belong they are someone they they come from somewhere they have a history and you know they have hopes and dreams you treat it you treat them that way and you are willing to communicate with them in a way that they want to communicate as opposed to the way we want to communicate. You know the mode you can get the results.

: Love it. I think it's great. Definitely want to dive into these results that you're discussing Abner. When I was in college one of my favorite classes was anthropology. I just loved anthropology is one of my favorite classes. Maybe my instructor was cool but you know it was just so intriguing to hear about different cultures and to learn the different theories. And I just think about what you and what your team does. You guys are like the health care anthropologists.

: That's really cool. I like it.

: And you could help people understand and communicate and in fact get the outcomes that we're looking for so the health care anthropologist right here on the line with Abner my friends.

: I love that. That's great.

: Hey Abner so definitely want to understand more about the types of results you guys are getting. But before we talk about that I like to learn a little bit more about setbacks. Like Can you share one of the setbacks that you had whether it be with ConsejoSano or something else in your career that gave you a pearl that because of it you never do things any different because of that. So can you highlight a setback and what you learn from it.

: Sure. So when I first had the idea to create ConsejoSano which means help the advice in Spanish it came from, I was doing work in Mexico as you know my previous company was a corporate wellness company in Mexico and so I saw that there were a lot of amazing things happening in Mexico and health care particularly using digital and the mobile phone. Mexico is emerging a growth economy. You had a growing middle class looking for solutions that were affordable and convenient and confidential and obviously high quality but cost effective and telemedicine was growing in Mexico faster even than in the U.S. at that point because they didn't have a lot of the legacy issues that restrain telemedicine growth in the U.S. you the U.S. we have this practice of medicine regulations each state you couldn't have a national solution you could not have for a while a national player in telemedicine because it made it very different because of the state practice of medicine regulations where a doctor had to be licensed in the state when the patient was. So some of that's changing now in the U.S. and so telemedicine I think is a big part of the future in the U.S. right. But this was like five years ago eight years ago I saw in Mexico that it was going really fast and there they didn't have those legacy issues you could have one license of the whole country. And you have a growing middle class looking for solutions and they didn't have a lot of infrastructure either. So you know their health care system wasn't as advanced. So in a sense they were able to leapfrog to something new because they didn't have some of the older legacy stuff in the way. So I saw that and I thought this is amazing you've got a middle class middle upper middle class Mexicans using telemedicine for health care. And I thought if we could and I met one of the largest telemedicine companies in Mexico I got to know them. They have an incredible service. And I had this idea in the U.S. you have very few doctors and providers who speak Spanish right. So if I could connect with the mobile phone, Hispanics in the U.S. with this call center, the telemedicine company in Mexico they had a huge call center in Mexico City that was serving the whole country incredible quality, fantastic operation, McKinsey and Company of a study called them a world class telemedicine solutions are really high quality. So here's my idea I said I'm going to connect Spanish speakers in the U.S. low income Spanish speakers in the U.S. with these doctors in Mexico by mobile phone you could tap your phone anywhere in the U.S. and you'd be connected in 10 seconds to a doctor in Mexico who is actually in Mexico treating upper middle or upper middle and upper middle class consumers. So it was a great way to provide a beautiful service to low income Hispanics in the U.S. who prefer to talk to Spanish speakers. Great idea right.

: Yeah.

: I thought it was and I thought it was a great idea but I ran into the buzz saw of you know the regulatory requirements U.S. it's very difficult. The part of the population that I wanted to serve in the U.S. was low income Hispanics most of them on Medicaid. That's a state federal government program. And they have very strict requirements about using actual resources. The bottom line here is despite the fact that we have a huge supply and demand problem in the U.S. there's no supply for the growing population of Spanish speakers in the US who just want to talk to a doctor in a telemedicine type visit even though the huge demand in the U.S. but no supply, huge supply just across the border of Mexico that we could tap into as the requirements around regulations wouldn't allow it. And so that idea might fail. Great idea but the lesson I drew from it was that great ideas are frequently all about timing. I still believe that at some point in the future we're going to realize that it's crazy not to allow Spanish speakers in the US to be able to talk to doctors who they want to talk to who they are comfortable with by tapping their phones. And that's just across the border. The only thing separating us is as you know as the border that signals don't recognize it. You can call it either. At some point in the future my idea I think will become somebody to make it work. Well it wasn't me, I was too early. So it failed that idea but it taught me a lot about timing is everything. Almost everything.

: That's fascinating.

: At a wrong time, still won't work.

: I love it. What a great story and a great lesson and also a very fine one that you tell it humorously and I'm sure its painful in your point.

: It's alright. Yeah.

: But I think it's great. I mean I love that you kind of left that open ended there because you know it is timing. Maybe one day it will work if we form some sort of form or group that I have to be accredited to be a part of and very well defined guidelines. I think there could be a way.

: Well you know just as an example just like we can't now use actual resources four or five years ago it was hard for companies in the U.S. to count television companies in different states across the country because of the state grants the medicine regulations that really you know made it hard for a doctor whose license in one state to serve other Americans in other states who want to talk to their doctor because he's not licensed in their state. And so that's good and slowly but surely no the law is changing. That's a legacy issue from the way health care and medicine developed in the U.S. but slowly but surely technology is worsening the laws and the regulations that change. So you're right Saul, eventually. First we'll have to make it so that be easy to do telemedicine across the U.S. and maybe we'll be okay with that they will be part of a new NAFTA right. we'll be a little like getting paid or maybe renegotiate NAFTA some years.

: Yes that's that's the way I think it should happen. I love that man. Yeah it's interesting right. I mean a big part of what we do with the podcast Abner and listeners as you well now is just we connect silos and even like at the state level is just so siloed. Sharing best practices, talking about what could happen, is the way that things do happen. I think it's great. So tell us back to the results right so you guys bring forth your cultural paradigm that you help your clients understand how to message, when to message, and then you do the translation which is kind of on the back end what are the results. Tell us about those results and maybe one are your most proud leadership experiences from those results.

: Sure. So the key for what I described and how we work culture first, then content, then language, then the mode of communication. Anyone who hears that the first time since "sheez man that's hard" and on a certain level it is right. And so what we know is that we can't do that at scale without technology that the only way to do that at scale is so that we're serving not a thousand people but more like 10 million people to build the technology that allows us that is small so our clients are typically man is Medicaid plans are provided with serving Medicaid populations are for profit but we do have a social mission very focused on trying to make sure that people at the low end of the income ladder get access to high quality health care. And so as we are building the technology that allows us to classroom and technology allows us to learn as we go. So what we give we get a client we start to do a deep dive into who that membership is whether it's a group of patients or members of a plan. We micro segment we use publicly available data we use data from the clients health plan data. We put all that together and we develop what we call a community detailing. We implement community detailing process and we microsegment all of those members are patients into different groups based on some algorithms that we've developed and then we start to develop content messages for them based on what we've learned about where they come from, who they are, what they believe. We do a lot of AB testing initially to make sure we were getting it right and then we start to communicate with them. We have a lot of success with text messaging so the mobile environment is very powerful but it's not text messaging as you think of it just affects. We can send the text message with a link to a PDF or a text message with a link to an audio file. We can do health risk assessments and other kinds of surveys via text message so the mobile environment is very powerful and every communication that we make is two way and it's recorded and through machine learning and natural language processing we're figuring out every time we interact with with a patient or member more about them so that we can then tailor the next method so that it is designed to connect with them even more. We're trialing in effect use technology to create an experience for them a communication an exchange, a conversation that sounds like it's a human being, and so doing that and we're building you know early stage. You know we don't have all the answers. We're still building but we are finding that we get incredibly a good result. So for instance one of the big areas our clients care a lot about is pellicle quality measures like this in the Medicaid space. Under these measures, some example is babies from the time they're born to the time they're two years old maybe 10 vaccinations I guess required by Medicaid and we can't give all the vaccinations at once, it takes a couple of visits. And so getting these multicultural populations these moms or dads who are responsible for the baby to understand they need to come in for these vaccinations and bring the baby up and get them to come in. It's hard. And so that ends are required to get a certain percentage of these folks to come in and the plan doesn't the Medicaid plan. They're paralyzed and so they come to us and they say look help us reach out to these folks and so we use our platform and our understanding to reach out and we're getting some cases with what we call never seen. We're getting 60, 70% of people who are responding to us who....

: Huge.

: Through all the other efforts by the plan previously they wouldn't respond. So not only are we getting them to you know there's a process here because these are low income people right there Medicaid. They struggle with life and so if you're struggling to pay the rent keep a roof over your head a vaccination or immunization may not be your priority. And so we've got to figure out a way to convince that person. It's important and then help lower the barriers to get them to come in. So we do everything in addition to explaining to them that they should come and build a trusted relationship so they'll listen to us. So we sometimes we schedule the appointment. We do the appointment reminder. We actually just signed the deal with lift so that we're going to be starting working with. So that is one of the barriers is transportation. We can incorporate that into our offerings so that we can get that person to the clinic. So our goal is to reduce the friction and to lower the barriers so that as we build a trusting relationship we can navigate that person and took care.

: Love that. I think it's great and kudos to you and your team for those results. It's important. It's a fragile population and hey for the plans they get to meet those objectives so why not partner with somebody that knows how to do it. And somebody from a plan listening to this or even a provider take into consideration the things that we're talking about and ConsejoSano's is a fantastic partner to consider. So with podcast notes you'll be able to find everything there including a link. And best way to contact Abner just go to outcomesrocket.health/abner and you'll find all that there. Getting close to the end here Abner, tell us about an exciting project that you're focused on today.

: Sure I'd say one is the lift partnership. We just announced that two weeks ago...

: Yeah congrats on it.

: It's a great opportunity for us to demonstrate that a On-Demand, non-emergency transportation benefit incorporated into new Medicaid or Medicare Advantage offering can really drive better results. And so I'm really excited about that in part because I think a lot of people forget who are in leadership positions in health care. If you take a day off or you need to go to the doctor take a hit of the doctor not to get paid for hourly workers going in for preventive visit like a vaccination or well child is that you don't get paid because you're hourly and if you're living paycheck to paycheck if you don't have transportation for example and it takes two buses and that's about an hour and have two hours to get there then you're at the doctor an hour and then two hours to get back. You're talking five hours. That person that mama, that dad, that grandmother whoever's responsible for the child, it's not that they don't care about the child. They're just trying to balance. If I take five hours off, number one I might get fired. Number two you know get fired. I can't make the rent I can't buy food. If we could make that five hour visit more like two hours because the lift on demand transportation benefit we can get that mom to the doctor in 30 minutes or less appointments an hour and get her back two hours. She then makes a calculation that we will all make a financial thing I can afford to take two hours off where I'm allowed I'm going to get fired but I can't take five or six years. So what it does is it drives this is that it's good for the clinic because the clinics labs you don't like no shows and of her maybe she had a ride and fell through or whatever. If we can have it in the moment. Well I mean this is what got. Using new technology these new offerings like Lift's which has an on demand service it can be there in five minutes. Not the old transportation benefit where you had the do you have scheduled weekend as they entered and they came around you and five other people. That's not what people want.

: What do they want?

: So I'm really excited. I'm grateful to lift. I think they are thinking really smartly about you know how they can use their amazing company they built the service, they built to improve health outcomes for low income people. So I'm excited about that part.

: That's awesome. Congratulations. I know Lift is working really hard to up their health care efforts and thanks to partners like you who are in the thick of it and be able to make it easier for people that actually need it. So congratulations on that.

: Yeah. Thank you. We're excited about it.

: Abner so this part of the podcast is right before we conclude we build leadership course. What it takes to be successful in the business of medicine, the one on one of Abner. And so I've got four questions lightning round style for you followed by a book that you recommend to the listeners. You ready?

: Sure.

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

: To make sure that solutions are designed to meet the needs of all patients not just some.

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

: I think that technology alone will solve problems in health care. There always has to be a human component there. And if you forget that it's a mistake.

: Love that. How do you stay relevant despite constant change?

: I think you really have to have a pulse on innovation in your space. It's not enough just to be doing good today because disruption comes fast and furious. And so you need to be you know using current things well but you've got to have your thumb on what's happening in your space in terms of innovation, who's innovating, who's got new ideas, and you should be testing them all with trying new things.

: Love it. What's one area of focus that drives everything in a health organization or at least your organization?

: I think outcomes I think we've got to have to get away from the idea that efforts are important. The truth is in health care what really matters are outcomes and we sometimes confuse efforts with results. Maybe I should a policeman. We should not confuse efforts with results. We need to focus on results which means health care outcomes and no matter what the efforts are if they are producing the results of the outcomes we want. We've got to switch it up.

: Amen and what book would you recommend Abner?

: It's an old book but it was important to me by a philosopher Karl Popper. He was a philosopher of science. The guy is called Conjectures and Refutations and it's a great book that teaches a lot about humility in science and I think that's a good thing to learn about.

: Outstanding what a great book recommendation and how about any favorite podcasts if not...

: Yours

: Thank you. I appreciate that. But any other ones that stick out or just stick with the book.

: I'll stick with the book and your podcast.

: You're too kind, you're too kind. Appreciate that. Folks for links to all the things that Abner has shared with us including a link to ConsejoSano. All the things that they offer their solutions the latest events that they've got going on. Go to outcomesrocket.health/abner and you're going to find that along with the full transcript of our conversation today. So Abner this has been a ton of fun. I love if you could just share a closing thought. And then the best place for the listeners could get in touch with you.

: Sure here is my e-mail. It's abner.mason@consejosano.com and Im sure you can put it up on your...

: Notes.

: And closing remark is just thank you, Saul for allowing people like me to share our thoughts. I think you're right that we can learn a lot from each other. We take the time and we now have news like podcasts that allow us to supplement and listen to other people's stories about people's experiences and we can learn from them. So this is a lot of fun. I think it's important work too Saul, thank you for doing it.

: Hey it's a pleasure Abner and appreciate all that you and your team are doing to make health care better and improve access. Keep up the awesome work.

: Great. Thanks a lot.

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Solving The Medication Adherence Problem with Omri Shor, Founder and CEO, Medisafe

: Welcome back once again to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. Today I have the outstanding Omri Shor. He is the Founder and CEO at Medisafe. Medisafe is an M health platform that solves medication not adherents. A huge billion dollar problem that we have in health care by addressing all the major underlying causes of this complex program including forgetfulness, fear of side effects costs, and lack of motivation and support. Today the app has 2.7 million registered users. So Omri, thanks so much. It's a pleasure to have you on the podcast.

: Thank you very much for the opportunity. And I'm looking forward to chatting today.

: Absolutely. Now Omri, tell me the one thing that I want to, that I always ask my guests is what got you into the medical sector to begin with.

: Sure. So our story begins in about six a bit more than six years ago. My father is diabetic and hypertensive and we're backing Israel, and on that beautiful day he came to me and he asked me a quick question which was "Have you seen me inject my medications today?" And I gave him a pretty quick answer that was low. I mean at that point no I haven't seen him. However I unfortunately understood that there's no you haven't injected your medications. He went back into the house and injected a second dose of insulin, in a room and that was completely mistaken. And we've started thinking about how people manage their medications as a result of that. What tools does patients have and what functionalities and so on and so forth? And Impalen, we've also started thinking about what does a health care grant ecosystem, actually does for patients in terms of medication management. So we clearly notice that these providers, payers, pharma companies, pharmacy, nurse coming any of his clinicians none of them had a solution that they could have provided my father that point in time. And at the same time, he carried an iPhone. So we thought that we can create the new medium for patients so medication management using solutions that are coming to the market.

: Well thank you for sharing that story Omri and hopefully, your dad is okay and he is just kind of a little misstep that led to solution being born.

: Absolutely my my is doing very well, he's actually Medisafe user number one.

: Is he really? Awesome.

: He keeps on notifying us whenever there is any issues or or any bogs or anything like that. We have one user who's notify us right away.

: That's amazing. And it's good to have that feedback loop with technologies like these and no doubt the hot topic here is medication adherents as it relates to this. Omri, what would you say health care leaders need to be thinking about?

: Yes. So medication here is part of a bigger problem which is medication mismanagement. And patients are lacking tools to actually help them better manage their medications. And that leads to a lot of burden on the health care system. It's a critical issue. And let me give you some of the numbers that when I found out about those numbers kept me awake for a few days. It starts with 700,000 people a year suffer in emergency because of medication management issues and of those 700,000 people, hundred and twenty five thousand people a year will die. And you translate that statistically, it's every four and a half minutes an American dies. For me, it was very troublesome. That according to the U.S. Congressional Budget Office leads to about 300 billion dollars of excessive expenditure. And that is because of additional admissions in additional emergencies and so on and so forth. Just imagine what the health care ecosystem could have done with additional 300 billion dollars a year. Right.

: Absolutely.

: Of course it does. It could have been billed. So it seemed to us like this is a huge issue. It's an unseen problem and something that should be brought to the attention of the grand health care ecosystem.

: You know like I like the way you framed it Omri, it's a part of the medication management problem that is medication adherents and so folks the best in any industry truly have the ability to make distinctions about whatever it be that they that they work on and Omri obviously is giving us a distinction here. Medication Management versus medication adherents. I think it's really really important to take in mind as we work to tackle this problem. Omri can you give us an example of how your organization and technology has created results. I mean, aside from 2.7 million users which is very impressive, what are some things that have happened to improve outcomes?

: Sure absolutely. So one minor correction today we have 4.5 million registered users.

: That's a major correction. Congratulations 4.5 million that's outstanding.

: Yes indeed that's a big population of patients and many people that we're helping. So this is exciting for us. I would like to say that when you look at a different constituents across the health care ecosystem many say for various outcomes for various stages. So I think that health care should be more focused on patients. So I'll start there. Medisafe helps hundreds of thousands of people each and every day to manage their medications correctly and what do I mean by manage medications correctly, that is starting from the basic reminders. She's a very important piece of the puzzle. However when you move further it's about educating the patients to for. There are two to factor that patients over time and so on and so forth. We're really looking to help keep continue for that patient from the moment that they're prescribe till the moment that they take their medication from health care. It's about looking at potential drug to drug interactions of that patient. And regarding that feature, Medisafe was able today to prevent tens of thousands of drug to drug interactions. We have received many e-mails from patients about how Medisafe literally saved their lives by identifying those interactions. So I think that we should start with the patient then when we move further into the health care ecosystem, our primary partners are in many cases pharma companies who are interested in proving patient experience for their patients. Of course that all translates into better outcomes, right. So imagine that we can improve adherents by 10% right. That we can move 21% of the nonadherent patients to become adherents. What are the implications for patients that are now healthier that do not need to suffer from any complications? And what are the implications to the health care ecosystem when you look at for diabetes patients for instance. There has been a study that showed that by improving adherents by about 20%, you save many hundreds of dollars a year as a result of that. I want to take it to one level higher because clearly it's important to improve outcomes for each and every patient. But Medisafe collects that level of data. So we have today over 1 billion medication doses that we're taking using Medisafe and about 6 million data points as to how patients take their medications right. Early health care stakeholders have claims data which is patients were taking their medications as pointing time. And that comes every 30 to 90 days. And then there's a lag. By using the Medisafe data, we move from a once a month to once every three months data sample to once to 2 to 3 times a day data sample. And we can understand patient behaviors in ways that were never available to us as the health care ecosystem todate and really get unparalleled insights into patients behavior, patient challenges, and how to solve them.

: Yeah that's fascinating Omri. And like you said right there's the individual patient impact. But then it's the broader population health. How can we manage the overall behaviors of populations whether it be community or whether it be a subset of a chronic illness? Fascinating work that you're doing and I think it's making a big difference. Can you share a time with the listeners when you had a setback and something that you learned from that setback that as a result you always do things a certain way.

: Sure absolutely. Let me start with one very important because I keep on getting to the patient right. Yes. So apparently although health care thinks that way, every patient is different. Because every patient is different, their challenges with medication management are different. Medisafe started the beginning we had a big vision but we started with features and functionalities that were one size fits all. However over time we've learned a lot about how to personalize experiences for users and one of them for instance is it's a very simple one. What is the call to action to go and reminds all to go and take his medications. And here is some very interesting insight for you. There are various ways to talk to patients and if I will go to a 50 year old patient and I will tell them hey "take your medications not only because it's healthier for you but because it matters for your family because you want to go and see your children or get married and support them over time. So it's not only for you it's for the family." We will see about 20% higher engagement from that. However, if I will go to a 20 to 30 year old millennial and do exactly the same talk about family values, we will get about 5% lower engagements. It's going to talk. So it took a lot of time to really start to see how do we think about personalization and that took about gazillion failures over where we kept on having many many challenges in bumping to walls until we have understood with our older values there. And remember I always thought of myself as a bit to see and to be company. So inside the health are ecosystem, there were many changes over the years. How do you prove. How do you prove veterans here. Right. And one of the things that we've found out is that the transparency of the data is not yet there. The access to data is not yet there and it only took us about five years until we had enough data so we could do a good enough data matching and be able to prove that value to the health care ecosystem.

: That's a really great lesson learned Omri and a great share for the listeners to think about. Let's take a look at the other side of that. What's your proudest leadership experience in health care today?

: So fortunately we are in place that we are working a lot with patients and we get patients sending us e-mails every day about how they can't imagine going through their patient journeys and their challenges without having Medisafe by their sides. There was one patient's specificically that told us "If I had on my phone just 3 apps, my calling app my texting app, and Medisafe, then my phone would fulfill what i seek.

: That's great.

: One in other beautiful example is a story of a gentleman called Richard and he used Medisafe to manage his wife's medication. However his stepfather used to take maintenance medications and at some point in time he was prescribed with an additional med. And then what happened is that he was prescribed with that med however, the pharmacists made a mistake and gave him a different med that the one that was prescribed. Richard then had Medisafe on his phone, so he went into interaction center to learn that if his father will take this mistaken med at the same time of the maintenance medication that he's taking, he's taking a severe risk of literally dying. So they then went to the doctor and the doctor indeed confirmed that there was a mistake there. So being at that point that you can help so many people be healthier and live their lives without the challenges of medication marriage is really an exciting place to be at.

: Now that's really exciting and an amazing stories that you've shared I'm sure many more. But some great ones that you highlighted for us and I'm just curious. So before this whole journey started Omri, what were you doing before Medisafe?

: So I always knew that my calling in life is to be entrepreneur and I worked for a startup in a completely different place. No firm management software. I was employee number one and it was in Israel where i startup. I was in charge of the entire business side. Initially it was reading the marketing messaging and after that working on how the product flows and then managing some of the sales activities it was a great time where I learned a lot of my intrapreneurs skills.

: Very cool. It's fascinating and so from that experience, were you able to bring over some knowledge and skills that have helped with Medisafe?

: I absolutely have. Human interactions human interaction when...

: Yes.

: You need to change the behavior of the secretary so she manages better. At is in some part is, it's similar to doing those things on patients. However, I think that business is business and you need to think about a business that you're building. Think about how you implement business models. How you help create value? How you quantify that value? And so on and so forth.

: It all goes back to value and one of the neat things that I think can happen is as we tend to get tunnel vision and healthcare and it helps to look beyond health care and see what other industries like legal for example are doing to solve problems. And it's amazing the parallels that you could find to apply it within health care. Sounds like you did a little bit of that on the legal versus Medisafe side. Appreciate you sharing that. And how about on Medisafe an exciting project that you're working on today.

: So in Medisafe for the last few years we've clearly been in touch with the big technology companies in our space. And about a few months back, Apple announced that they're allowing patients now to hold their health records information into their Apple device. And when we heard about that we thought that it is very exciting, it's reaaly breaking the barriers inside the health care system creating a true interoperability on the patients as opposed to the industry's side. And then we thought that the ideal thing to do is when the patient actually has their medical records and clearly medications are part of that to be able to pull that into their Medisafe account and create really frictionless and accurate medication loading into Medisafe. So on June of this year, Apple announced that they will open health records API...

: Nice.

: On their press release, there were a number of beautiful screen shots those screen shots were Medisafe.

: Oh where they really? Nice.

: To be the first company to actually take the medication data from the health records and hold that into their patients Medisafe's account. So were hardly on no final datas of this thing in intending to launch the future officially this fall.

: Outstanding. Congratulations on that.

: Thank you. And that's on the patient side right. And as I said, the biggest challenge is to run those two companies at the same time, in the business side in the consumer side. So on the business side we are in the process of really implementing Medisafe together with more and more pharma companies in creating value for them by managing patients medications for action.

: Outstanding and you've provided such a great example Omri of being able to create a DTC company add value there while at the same time creating a B2B model that works hand in hand with your B2C model. And I think it's a great example one that entrepreneurs out there looking to make an impact in health care should study. So folks check out Medisafe, medisafe.com and the things that they're doing just an outstanding group. So let's talk about this syllabus so we're going to do a quick lightning round Omri. We're going to build a leadership syllabus on health care. The business of healthcare the one on one on business with Omri. And so I've got four questions for you lightning round style followed by a book that you recommend to the listeners. You ready?

: Yes.

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

: I think that you should make sure that you're taking a strategic approach to how do you validate the value. And do clinical great studies and validate your solutions.

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

: I think it's very important to keep on focused to identify where you are going and understand the market and the market dynamics and just keep focused on what you're trying to achieve.

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

: Always identify your target population and your consumers, your customers understand what they're looking for in an ever changing world. Continue on interviewing them and adopt the solution very quickly. Figure it quickly. Listen to the market and bridge those gaps constantly.

: Great advice. What's one area of focus that drives everything in your organization?

: Patients. Patient reviews each and every day. If you lose sight of the patient and what you were and how and what's the value that you generate to them you lose grape of the business and data is key. So we keep on looking at the data and looking at what our patients need and keep on training.

: Love it. Love it Omri and what book would you recommend to the listeners on this syllabus?

: So there is a great book called the Blue Ocean Strategy. Strategy book that essentially tells you stories of companies that were able to substract values from their products and add various other values instead and my dad created the Blue Ocean is supposed to read the ocean where everyone else is competing. So essentially it's how you differentiate yourself from your competitors based on the value that you can bring to the world.

: What a great recommendation Omri. I picked that book up probably about 6 years ago but this is a good reminder to pick it back up again. Listeners if you haven't read that, it's such a refreshing way to approach you creation and look I mean Omri's doing an outstanding job. Him and his organization. This one popped up on his syllabus here for you, so you better read it. So Omri, thank you so much here to the end, I really appreciate your insights. Before we conclude though I love if you could just share a closing thought and then the best place where the listeners could interact with you and your company.

: Yes. So first of all thank you very much for your opportunity to talk to you today. I think that it's important to understand that better health care and for us are medication management has a ripple effect across the industry. By focusing on the ones who matter most the source of this problem which is improving medications for patients, I think we can improve health outcomes across health care continue. I would be happy to stay in touch you can find me on re short LinkedIn and you can reach out through the Medisafe website and click Contact Us and those e-mails go to my inbox as well.

: Outstanding. Omri, thank you so much. Keep up the outstanding work on this medication management medication and here in space you guys are doing outstanding things and leading the way. And thanks again for spending time with us. It's been a pleasure.

: Thank you Saul, enjoying the opportunity to talk to you today. And I'm looking forward to staying in touch.

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How Accountability and Public Access to Information Improves Outcomes with Leah Binder, President & CEO of The Leapfrog Group

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

: Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. Today I have the outstanding Leah Binder. She's the President and CEO of The Leapfrog Group representing employers and other purchasers of health care calling for improved safety and quality in hospitals. She's a regular contributor to Forbes.com the Huffington Post and The Wall Street Journal Expert Forum. She was named on Beckers list of the 50 Most Powerful People on Healthcare in 2014 and consistently cited by modern healthcare among the 100 most influential people and the top 25 women in healthcare. Under her leadership The Leapfrog Group launch from Leapfrog hospital safety grade which many of you may already be familiar with but if not we'll be going into that within this podcast and in a science letter grades assessing the safety and general hospitals across the country. This is a very important platform with which many of us can keep track of how hospitals are doing and if they're the ones we want to go to. She's also fostered groundbreaking innovations in the annual Leapfrog Hospital survey including partnerships to eliminate early elective deliveries, central line associated bloodstream infections and safe use of health technology. So it's a pleasure that I invite you Leah to the podcast. Thank you so much for joining us.

: Thanks so much for having me. This is great.

: Absolutely. Now that I leave anything out in that intro that you want to highlight to the listeners?

: I think you captured pretty much more than you should of.

: Oh boy. Well hopefully. I thought it was on point. And anything that maybe you would like to see less of maybe.

: It was a very nice introduction. Thank you.

: Thank you, thank you. I appreciate that. Well it's a pleasure to have you here on the podcast, Leah, you're definitely doing some wonderful work in our space and our shared space of health care. Why did you decide to get into the medical sector to begin with?

: Well I think really it started when I was fairly young when my father died of a heart attack and spent some some time in the hospital before he died. So about six weeks so I got a firsthand look at the pretty young age. I mean I was just 20.

: Hard stuff.

: Really got real exposure to what the healthcare system is like. And actually in a positive way even back in the 80's healthcare and hospitals were very adept at handling cardiac issues and cardiac trauma that actually is a great strength. And my father got excellent care although I'm sure there were problems I probably didn't understand that at the time I was overwhelmed as anyone would be. But that was my first exposure and recognition of just how important healthcare really is. I think a lot of people who are that age in their 20's, 30's kind of think we're immortal at that age and everything. You don't have to worry about healthcare right now but you know what the ambulance could be shown up at your door any minute and taken away one of your loved ones and suddenly healthcare becomes urgent to you. So for me it was a recognition that even I was never interested in being a clinician and still I'm not. Thank God there are so many other really smart people who are interested in being clinicians but I'm not. But even though I wasn't going to work in the health care system that way I recognized it's extraordinarily important to me and I really wanted to help make it better.

: That's awesome yeah. No doubt it's a space where when we get struck with an illness or somebody that we love gets struck with an illness it's hard to think and to sift through what the options are. You've been in this space for a while. You've made your contributions. What would you consider is a hot topic that needs to be on healthcare leaders agenda today and how are you guys addressing that?

: Well I think one of the hottest topics is value and people are throwing that word around. Nobody really defines it very well I think except me. I define perfectly.

: Let's hear it Leah.

: I should have that in my introduction. Definer of the word value. Well anyway we define it as the right care at the right price. So it's a combination of care and price and I think sometimes there's an assumption that value means price only at its cost only and it does not mean that we don't think of that when we are trying to get a good value for a car for example. You don't think that means I'm going to take any jalopy as long as I can get a low price. That's not what we're talking about we're talking about that combination, that sweet spot between getting excellent quality and excellent price and affordable price so I think that's that combination for value and it is a big topic right now. There's a real shift that's happening out of fee for service toward this concept that we should pay the healthcare system for delivering the outcomes the right outcomes at the right price. And therefore we should negotiate on the basis of those outcomes and not on the basis of each individual service that's delivered in a fee for service setting. Now we have not gotten there. We talk a lot about it. And I would say even though we say something like 70% of all health care is now in some fashion tied to value. Sometimes that tie is tiny and really the predominant method of payment right now really is fee for service that's shifting and changing and there's a real effort to change it both at the policy level here in Washington where I work and also in the private sector purchasers that is a major movement and it's really happening. And I think any provider who's not intensely focused on what that's going to mean for them is missing a major part of their business.

: The right care for the right price. And as we look to tackle that. I mean it's tough right and we've we've had guests on the podcast from the employer perspective. We've had folks from Walmart and Intel that are taking this from the perspective of the employer and now they're taking internal measures to measure quality and report to these health care providers how they're doing. But what are the - I mean I guess that's a fraction of the employers out there you know what can employers do to take a better leap toward this value-based care?

: That was very good that you used the word leap.

: Leapfrog.

: That's why we're called Leapfrog and that's why because we the founders of leapfrog back in 2000 they didn't want incremental change in health care. They wanted giant leaps forward in the quality and safety. So we're called Leapfrog that's why we're calling for.

: And you know what. Maybe rather than assume why don't we just level set the listeners on Leapfrog the services that you guys provide what you do and then maybe we could knock out that question.

: Sure. So we're non-profit. We were founded in 2000 as I said by employers some very large employers who joined together and then invited others ended up being about a 175 large employers who were in the founding group. So these are companies like Boeing, Marriott, Walmart you mentioned who came together and said that they really wanted to publicly report on the quality and safety of healthcare in this country make that available to their employees so that their employees couldn't sort of shop for the right kind of care. And they were frustrated that the kind of care they thought their employees were getting was not as it should be and that they were operating in a environment that was so opaque that their employees never knew or had no way of knowing who was the best provider of care in the market. And so I think a number of our founders such as automakers for example would say well our products are in the public domain. They're subject to high levels of public scrutiny. There's 10 magazines on the newsstand that compare our cars against all of our competitors on every factor of interest to consumers. Why is it that we can't do the same thing with hospitals? Why can't my employees look at hospitals in the same way and compare them in the public marketplace on the factors that matter to them? And that's why they formed Leapfrog, they said well let's bring all of our purchasing leverage together as employers and let's ask hospitals to voluntarily give us information that we don't have otherwise so that our employees and really the American public can start to compare among hospitals. Not only will that give them the opportunity to get the best possible care but it also will ultimately elevate quality and safety of care for everyone. We know that in a competitive marketplace can have that impact. So they started Leapfrog we started in back in 2000 asking hospitals voluntarily on behalf of these several hundred employers if they would please give us the following information on their safety and their quality. And that 200 did in the beginning today. It's almost 2,000. And that is...

: Nice.

: About 2/3 of the hospital beds represented in our survey which is quite a lot. And we asked some very sophisticated questions now about quality and safety. Still information you can get nowhere else. So example being c-section rate if you want to standardize c-section rate by hospital across the country. So you can compare your hospital how they look compared to others in the country or in your state. You get that from Leapfrog and nowhere else. I wish it were available somewhere else but it is not. So we just collected by asking and now we have you know thousands of employers involved. So we have a little bit of persuasive ability and that's what we able to do. That's Leapfrog and then we also do some ratings as you mentioned we rate hospitals on their quality and their safety but particularly we give letter grades A, B, C, D or F to hospitals on their safety. Something that's very important for people to look at before they go hospital because it's the third leading cause of death is errors and accidents in hospitals so you're wise to go and check that out before you walk in the door of a hospital. And employers pay for this in addition to worrying about this. They pay for it. And it is very expensive. So we really need to be holding hospitals accountable for much higher levels of safety.

: Outstanding. What a great level set there. The on again folks talking to Leah Binder President and CEO of Leapfrog Group. So working through this, Leah, can you give us an example of how your organization has created results by doing and thinking differentlyO obviously you're thinking differently you're doing differently. But tell us about some of the outcomes that you've been able to produce for either employers or consumers.

: Well we've actually had quite a number of successes that have been very exciting. One is I mentioned c-sections just now employers pay for half the births in this country and childbirth is the number one reason for hospitalization. There are far more childbirths in hospitals than anything else that happens in hospitals. It's the number one thing by far. And so our c-section is the number one procedure in hospitals. So for obvious reasons given that purchasers have such an involvement in paying for maternity care they're very interested in it. And at the same time our federal government which tends to look at almost everything they look at is for Medicare populations. They tend to not look at it because they're not interested in maternity care so much for Medicare population for obvious reasons. Anyway, so we are really becoming increasingly the locus of important information on maternity care. We started reporting on something called early elective deliveries. These are deliveries that are scheduled prior to mother nature schedule. So but not too far prior to mother nature's schedule so pregnancies typically last about 40 weeks. These deliveries are scheduled between 38 and 39 weeks so just the very tail end of the pregnancy. The idea is to schedule and prior to mother nature so that it can actually happen at a time that is let's say convenient or just for whatever reason meets the schedule of them either the mother or the obstetrician or the midwife. The problem with doing this is that all of the evidence suggests that it is not safe that actually this is not good for the newborn that these newborns often end up in the the NICU. And there's even some evidence that it causes long term developmental delays in the newborn. It also tends to result in a higher level of intervention in the childbirth experience which is riskier for the mother. So on many levels these should not be scheduled without a medical reason and sometimes there's a medical reason. But in a lot of these cases there isn't. And the association that represents Obstetricians and Gynecologists called ACOG has recommended for over 30 years, over 30 years that obstetricians not schedule these deliveries this way. Nonetheless they've been they've been going on. So finally we had a good measure we could start to ask hospitals "do you do this?" and it's a complicated way of asking but we ask it and we started doing that in 2010. In 2010 about 17 percent of deliveries were done this way. They were early elective and that is a pretty high percentage that was on average but we saw just incredible variation even in the same community we'd see anywhere from 40% in one hospital to 2% another. So just an incredible variation. That was back in 2010. So fast forward today and over the last eight years we have seen a remarkable decrease in these deliveries because...

: Really?

: Having publicly reported them made all the difference. It really galvanized a lot of change. So even though ACOG and also like March of Dimes has been trying to prevent these. Despite that they haven't gotten any traction until we were able to say, "well wait a minute this hospital has a rate of 30%. Why?" And once you start naming the hospitals and showing the difference you really had an impact. So we saw just a remarkable effort that came from hospitals, providers and leaders to really address this. And we take credit for galvanizing that through transparency. And so today the rate is on average 2.8%.

: Nice.

: Basically the problem is gone. That is an example. There are literally hundreds of thousands of babies who did not end up in the NICU as a result of this effort. And this was a purchaser driven effort. And it's all about transparency. So that's really what Leapfrog's about.

: What a great great story there and that's for sure. I mean gone from 70% to just under 3 percent is no small undertaking in this system. It's hard to get things done.

: Right. Exactly.

: Yeah they have that type of impact is huge so big congratulations to you Leah and your team for being able to drive this.

: Oh well thank you but again all we did was publicly report what we do everyday and what was the real work was from the providers, the hospitals, the organizations but that public reporting was not easy. And that's the piece - and we didn't do it just because sitting in Washington. You know I'm so good at getting data out there. It's because purchaser's go door to door to these hospitals and they say we really want you to report to Leapfrog. And that's not an easy thing to do.

: So big kudos goes to the employers to then.

: Yes.

: They were going after this.

: Employer leadership saying we want this data, we deserve this data, it's important to us and that's made all the difference. So every employer listening to this right now, take a look at what you're doing to get Leapfrog out there because without Leapfrog, employers do not have their own conduit for data that's important to them. You might have some CMS data which isn't as good for you. It might be good for Medicare but you if you want your own data, Leapfrog's here that's where you're going to get it and that's where you're going to be able to drive change.

: Friends, listen to that hit rewind because there are some huge value added in this discussion in particular just understanding the difference between CMS catering more toward Medicare versus other larger group that you're currently covering if you're an employer. So big big value there given to us by Leah. So what would you say, Leah, what's the criteria like how do you go about choosing what you're going to go after?

: Our number one criteria. Well we have two no. 1 criteria if were allowed and that is that it has to be relevant and important to purchasers and consumers.

: Got it.

: Because if purchasers actually don't think it's relevant to them if it's not relevant to their employees. And so it has to be relevant to both and that it matters to us. And that sounds like a simple thing but it's not a simple thing. Be amazed at how much data is collected and publicly reported. That is not relevant to them at all. It's sometimes it's relevant to providers. We have a lot of things that are collected out there that are what we call process measures things like when certain things take place in the delivery setting that lead potentially to good outcomes, but we don't know that for certain all the time. But if a medication is administered at the right time etc. while we do look at some of those process measures to make sure the delivery setting is functioning in a safe way, that is more important to providers themselves who want to make sure that they are consistently doing what they should be doing. But we're looking for whether they're getting the right outcomes so we are mostly focused on or to the extent we can be, we're focused on outcomes.

: Yes.

: What's the rate of c-section not just"are you doing everything you can to prevent c-sections." So we look at outcomes, we also are like structural measures not as much as outcomes but structural measures like do they have in place the kinds of management structures they should have in place to prevent errors in accidents and bad things? So we look for example do they have the right technology in place to manage medication orders? You'd be amazed at how easy it is to make a major medication error in a hospital. In fact, they make a lot of them it's about 1 a day per inpatient so it's a big deal, some of those can be minor errors but some of them can be major even sometimes fatal and it's so easy. So we want to know all the steps that the hospital is taking and whether those steps actually work. We test our technology. So it's a very really important test and that's something that's very important to purchasers from day one. They said, "we just want a medication errors or a big problem, it makes sense to us that those should be managed through I.T. systems, are they using them, are they using them effectively or not? So that's something we look at. So we're really looking at issues that again we can't get anywhere else, important to purchasers, important to consumers and that make a difference.

: Outstanding. Wow. That's really great, very clear and concise outline there for criteria. So what would you say, I feel like a lot of times Leah, we learn more from setbacks than successes. Would you say that there is a particular setback that you guys had in the last 10 to 18 years that you've been around that you learn a lot from?

: Well in 2010 we actually had a major moment as an organization and for our board. So we were founded as I mentioned 2,000. We came out of a report that was issued by the what was called then the Institute of Medicine and that report was called To Err Is Human and it said that there was upwards of a hundred thousand people dying from preventable medical errors in hospitals. So that report got a lot of attention and Leapfrog really came out of that. So the real first and continuing focus of Leapfrog has always been errors and accidents and hospitals and trying to prevent them trying to drive a market for safer care for people so they know which hospitals are safer than others so they go to those safer ones and they encourage through competition that hospitals improve their own safety. So that's been our focus and we started in the 2000's collecting that data through the survey voluntarily. We asked hospitals about their safety record through our survey and we publicly reported it and then we made that information publicly available, and that's been the model that Leapfrog has had from the beginning. So in 2010 though, there was a lot of press coming out about the first decade after the 10-year anniversary of To Err is Human. Have we made progress on medical errors was the big question that was sort of out there and the larger world particularly among health policymakers and there were about about five different studies done by a variety of different organizations on that question and every one of them concluded, "No we have not made progress." And if anything the problem is worse than we thought because now we're better at measuring the safety than we were 10 years ago. That is something that did improve. We got better at measuring it and as we get better measuring it we realized it's worse much worse in fact now we think it's at least twice as many people than that die 200,000 at least die from these preventable error. Anyway, so ten years in for Leapfrog, this was a moment for us. We said, "well okay the problem got worse, this was our main focus why we came to be. Are we wrong? Is our entire concept wrong? and we've been doing something completely just our whole methodology wrong everything we're doing our whole vision mission or is just not the right direction.

: It was an existential moment.

: There really is.

: Yeah.

: And what we concluded was and we had about at that point about 700 hospitals reporting voluntarily. And what we concluded was that voluntary was the problem, that the biggest problem we had was the hospitals that didn't report to us got a pass. So even though in most cases we reported them has declined to report. And that really wasn't enough to embarrass them for not reporting. And it got a pass. So if a hospital in a community said I have a bad infection rate and they admitted on our survey hospital next door might also have a bad infection rate but they decided not to report and they get the pass. And everybody said figures well the other one must be fine. The one that didn't report so it didn't work because you can't have competition when people can voluntarily opt out and decide not to compete. So that's when we launched out of that the hospital safety grade which was A, B, C, D, or F that we assigned to all general hospitals regardless of whether they report to us. So it doesn't matter if they want it or not, We don't ask them for anything. We just use the data that we have publicly and we assign them this letter grade, and we do it very carefully. We have bunch of experts dream team of experts involved and we use a great deal of scientific research that goes behind every single measure we use every single aspect of our methodology etc. So we're very careful about it. But we do assign it and it is not voluntary. So that has really changed. That has changed everything and we are seeing progress as a result of that.

: Wow just finding a new way to hold people accountable and because the non-participation is really kind of unfair and just to, how did you guys come up with that? I mean that's such a unique approach to tackle this issue and obviously it's working. What was the spark that ignited that idea?

: Well actually one of our board members David Goldhill, he talked about in L.A...

: Yeah.

: They had the hygiene department in L.A. so the public health department in L.A. had a program where they assign letter grades to restaurants on their cleanliness. So instead of just kind of reporting all the rats and the infestations and all the other stuff that they find God knows what in restaurants they gave me a grade. And they required the restaurant to post the grade the A B or C on their door. And when they started doing that, immediately, they got better immediately the restaurants got better, I mean pretty much within a year every restaurant was either an A or are pretty much out of business because...

: Wow.

: People really...

: I wanna go there.

: Got people's attention. Right exactly.

: Yeah.

So I had a big impact and even saw impact on emergency visits for food poisoning and stuff. And it really had an impact. And New York City has done it as well successfully so we thought well let's do that for hospitals. We'll just assign them a letter grade. Now we can't require them to post it on their door but we can at least give them letter grade. We can get some publicity for it. And so that's what we've done, we updated every six months so we get a lot of publicity every six months when we update the letter grades nationally and regionally. There's usually a lot of attention. I think it's had an impact for a lot of boards of hospitals which is an area that I think is important. For example we have lots of stories of board members who come into their board meeting and say, "you know for two years you've been reporting to us on all the progress you're making with falls or infections or all these problems and all those great work that you've done and improvements, but we got a D. Why are we getting a D?" And so when board members ask those kinds of questions. The board mates has a real impact on the entire hospital, the leadership involvement just changes overnight on safety so we've seen impact like that, the letter grade just has a real sense stickiness get traction and people listen to it and people pay attention which is important and I will add one thing I think others you know yeah it's not like this is the most genius idea in the universe at A,B,C,D or F, I mean people you know you've heard about grades obviously. What's different though is that Leapfrog because we're independent because we were not in the healthcare providers side at all. We're very careful about in fact a real wall between us and the those we rate, because of that separation the independents were actually willing to give some bad grades.

: Yeah.

: And I think for many organizations that's a line they couldn't cross. But we can and that really even though we don't give a lot of terrible grades we don't get, it's really not something we relish we don't enjoy giving really bad grades but we give them a lot to make it clear that they're willing to tell the truth and he is candid as possible and we're willing to celebrate hospitals when they do well because we certainly give a lot of A's as well.

: What a great message there Leah and that inspiration from one of your board members to use this system that worked in the food industry, I had our guest recently Lucianne over from the Netherlands tell us, "you know what once a year, twice a year if you can attend them a meeting that's completely unrelated to what you do." He's like go to a plumbers meeting or go to an arts and crafts meeting because you will find something that will get you out of your box.

: Yup. So true

: And I thought that was such a great recommendation especially with your solution here.

: It's so true. I think that's one of the techniques we use actually...

: Really?

: As kind of a discipline in our planning and strategy is, what do other industries do? And sometimes you can really get some insights because healthcare traditionally we think of ourselves as completely different...

: Yeah.

: Completely outside it we're just so unique. But actually there's a lot of lessons to be learned from how other industries pursue odd issues.

: Wow. And this is a great example of that just the pivot that you guys made as an organization and the results that followed. So tell us about an exciting project or focus that you guys are working on there.

: Well we're really excited right now because we're working on a ratings for ambulatory surgical surgery centers and outpatient surgery so we're right now Leapfrog rates inpatient hospital care including some surgical procedures we look at the volume of particular surgical procedures but we're going to add to our survey and we're going to look at surgeries performed in the outpatient basis as well. And again we're also going to look at surgeries performed at ambulatory surgical centers which will really require a new survey available to ASC's that they can complete and publicly report their own quality and safety data. This is a big deal because about 60% of surgeries are now performed on an outpatient basis and a lot of them now are moving into these ambulatory surgical centers. And there is relatively little quality or safety reporting available to consumers or purchasers to compare among them which is deeply concerning. They tend to be lower priced, but back to my definition of value it's price in the right care price and quality. And we don't have the quality side of that equation too often with outpatient and ambulatory surgical centers. So hopefully we'll be able to change that fast.

: Well you guys have definitely done great work in the acute space Leah and there's no doubt in my mind that with the models you've established then the track record that you have that you're going to be able to do that in a much shorter time frame. So very exciting.

: Thank you. Yeah we're very excited about it and we do welcome any ideas or feedback from people as we look to this new area particularly with ASC's and this is really a part of the health care universe that we don't know as well. We certainly know hospitals we don't know ASC's as well and I think it's growing so so quickly and evolving sometimes I think they don't know themselves as well either. So we're we're starting to learn how the market works but we are always welcoming of suggestions.

: There you have it folks. If you're if you're looking for ways to collaborate to this tremendous effort we'll give you a way to reach out to Leah and her team here at the end. Leah getting close to the end of the podcast here the time flies when you're having fun. We got a little lightning round here for putting together a medical leadership course on what it takes to be successful in the business of healthcare. The ABC's of Leah Binder so I've got four questions lightning round style followed by a book that you recommend to the listeners. You ready?

: OK.

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

: You have to care about them deeply.

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

: Not being transparent.

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

: Eyes on the prize. What's important to the patient in the bed is always the most important thing even when you are distracted by a zillion other things.

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

: Safety. Safety is the bottom line. It's about respecting the patient enough to think about their well-being and safety in the most mundane ways and simplest ways 24/7 and that's the focus once you focus on that, everything else will follow.

: Safety is key. And what book would you recommend to the listeners as part of the syllabus Leah?

: I have a book that I love, Cracking Health Costs is published last year and it's by Tom Emerick and Al Lewis. Tom Emmerick's former Global Benefits Senior V.P. for Walmart, Al Lewis is a great innovator runs a company and he's also an expert on care management. They have assembled a series of chapters on really innovative approaches that employers and others can take to reduce their health costs but also to do it in a way that again looks at both cost and quality at the same time and gets better outcomes for their employees. They're also really funny and that with a book.

: That makes it a minute's entertaining and informative. That's really good.

: Yes exactly it is fun to read.

: That's awesome. Listeners you could find a link to this book as well as a transcript of our discussion. The syllabus that we just built for you all add outcomesrocket.health/Leapfrog. You'll find all of that there. Leah before we conclude I'd love if you could just share a closing thought with the listeners, and then the best place where they could get in touch with or follow you.

: My major thought is this do not become distracted by the language and the intensity of healthcare clinical practice so much that you lose sight of what's really important about healthcare which is the values that cause us all to care about it. What's important to the patients and families. What's important to all of us for our own families to have a respectful and effective health care delivery system. Let's not lose sight of that through the smoke and mirrors that sometimes happens in health policy or clinical practice let's keep our focus on the values that drive us forward.

: What a great message Leah. Thank you for that. And what would you say the best place to contact you say somebody interested in collaborating on your ASC initiative or in general to find out more about you or how they could get involved.

: They could contact me at lbinder@leapfroggroup.org

: Outstanding. That's the email you have it folks. And again you could find all this information and outcomesrocket.health/leapfrog. You'll find Leah's email as well as all of the links that we've discussed. Leah, it's been a tremendous pleasure. Keep up the amazing work and we really appreciate you spending some time with us today.

: Thanks for having me. It's been a pleasure.

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

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Recommended Book:

Cracking Health Costs: How to Cut Your Company's Health Costs and Provide Employees Better Care

Best Way to Contact Leah:

lbinder@leapfroggroup.org

Mentioned Link:

http://www.leapfroggroup.org/

Check out this link:

https://outcomesrocket.health/podcast

How To Create Actionable Value Based Care Policies and Best Practices with Chris DeRienzo, System Chief Quality Officer at Mission Health

: Welcome back once again to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. Today I have Dr. Chris DeRienzo appointed member of North Carolina Medical Care Advisory Committee. He's a dedicated husband and proud father and also a triathlete. He's also a physician executive dedicated to improving health for all Americans and currently serves as a chief quality officer for Mission Health. In this role, he gets to practice neonatology with Mission Children, teach as an adjunct professor of pediatrics with both Duke and USC and volunteer as a member of the Blue Ridge Regional Hospital Board, the Mercy Health Board quality committee and the YMCA Blue Ridge assembly board mission Impac committee. He's board certified in both pediatrics and neonatology Dr. Dary Enzo completed his M.D. Master's in Public Policy and postgraduate medical training at Duke. He's certainly passionate about what he does for populations and it's a true pleasure to have Chris on the podcast with us Chris. Welcome.

: I'm happy to be here,Saul Thanks for having me.

: It is a true pleasure my friend. Now did I leave anything in that intro that maybe you want to share with the listeners?

: The only thing I might add is I'm a mediocre triathlete at best.

: Hey listen you know how to finish them and that's all I care about my friend.

: Amen to that.

: I was able to do two triathlons and man major respects. Do you do the Olympics, do you do the sprints? What do you prefer to do?

: So I started in the in the shorter course. And I actually just did it an Olympic. We were visiting some friends in New Jersey this past weekend. But I'm trying to work out towards the Iron Man. It is a lot of training and I have an incredibly understanding wife.

: Oh my gosh. That's awesome. Well if you're shooting for the Iron Man, I've never done it but I admire those that could get it done. And if you apply even a fraction of what you've been able to do in your career and what you do and what you love so much, I have no doubt you'll be able to finish it.

: I appreciate that. We shall see come mid October.

: Fingers crossed. Hey so Chris why did you decide to get into the medical sector?

: Yeah when I was a kid I was really interested in science and I had this fantastic neighbor who is an oncologist and she took me into her lab one summer she was doing great research on cancer science and I thought it was really cool but I felt like I was missing something. And finally one day she brought me to one of their cancer conferences where they talk through patients and what the best strategies were to help treat this cancer that cancer and something just clicked for me and I said wow I can really very directly have impact on individual people's lives and on lots of people's lives at once by getting into benison and once that's sort of been struck I was off and running.

: That's so cool. So from the very beginning Chris you were interested in and impacting populations at large. What would you say today, you know now fast forward to where you are in your career and as a healthcare leader is a hot topic and needs to be on every medical leaders agenda and how are you guys addressing it?

: I think that we are clearly undergoing a time of great transformation in healthcare from the way that we think about providing health care to what's available to us to treating patients not just inside the four walls of our institutions but throughout the courses of their lives. So I think if folks are not innovating today, if they're not continuously improving then you're already ten steps behind the rest of the field.

: Yeah you know that's a really great call out. And so as a health leader within the system, a provider system - what type of advice would you give to others trying to do something trying to innovate?

: So within Mission we've been really successful in innovating through our continuous improvement pathways. And so the way that we think about continuous improvement is kind of like fishing. All right so you've got to first teach folks that it's part of their job that they need to fish. Otherwise they don't know that they either can't do it or need to do it. So right from day one, the Chief Operating Officer of our system in day one of orientation tells everybody at mission that you've got two jobs. First to do what we hired you to do as well as you possibly can do it. And second figure out ways that we can make it better. And so we go folks who join the team in from the very beginning that continuous improvement is in our DNA. And so once you know that you need to go fishing you need to have some tools to fish. So we equip folks through a variety of different trainings with the tools that they need to perform continuous improvement at the bedside and finance and H.R. you name it. And we use a variety of tools including analytics platforms more basic continuous improvement methodology and then we teach folks how to use them. So once you've got your fishing pole unless you know what to do with it you know it's not of much use to you. So you've got to focus time, energy and resource on training and coaching on how to use continuous improvement tools and methodologies relevant to whatever that individual's area of practice is. And then finally once your teams begin achieving great outcomes and you know that they will because equipping folks at the frontline - frontline managers line level leaders with continuous improvement methodology is all of a sudden their eyes are open to the opportunities surrounding them and they will achieve outcomes. Their leaders have to then positively reinforce it. And so we highlight those outcomes everywhere we could possibly think about it. We have quality awards every year. It's on their boards, at their units, in their clinics and it begins to generate this profound flywheel effect on continuous improvement.

: Chris I think that's wonderful and it's very clear to me that continuous improvement is inside of the very fabric of the culture of your organisation from the beginning through out the individuals' careers their mission and I could hear the passion in your voice for this continued improvement that leads to those innovations. You use the fishing analogy I recently had a guest on a podcast that talked about you've got to keep tension in the line and that tension in the line always helps you understand the communication between you and the things that are going on within the organisation. And I think it just meshes really well with the example you've provided. Can you give the listeners an example of something that's come out of this culture of continuous improvement?

: Absolutely on the clinical side we structure that continuous improvement around something called care process models and so a care process model team comes together around a clinical condition or a disease state and very purposefully walk from start to finish through what are the best practices nationally on driving patients to the best possible outcome with colon cancer, with lung cancer, with paediatric asthma and so on we bring those teams together and we give them 90 days and say in a 90 day sprint We need you to find the problem. Figure out what the best practice is we resource the clinician who leads a team with a member of our performance improvement team with informatics folks, with an analytics resource, with education resources, and then with all of the folks in the clinical care team who are relevant to that condition so if it's in the clinic environment we're talking about medical assistance, nurses, pharmacists if it's on the inpatient environment you know care managers are there and so and so forth. So we empower that team to tell us what is the best practice said it mission we need to build into our workflows and then we build it we build it into the electronic medical record in a workflow that is as frictionless to use as possible which makes it easy to do what our CPM has decided is the right thing and just a little bit harder not to follow that pathway. But that's not enough. You then have to measure outcomes. So we've built the analytics environment for each and every one of these care process models so that we can get to a physician, provider and a patient level and know are using the pathways making a difference on relevant clinical outcomes. So for example in the inpatient world if we're using the sepsis CPM what the differences look like in patient mortality, in readmission rate, in length of stay, in cost per case. And right now I could pull ups Saul across over 60 of these care process models and if you were you know one of my supervisors you would say Derienzo "you know if you look across our group most folks are using the pathway 80 percent of the time and this is what their outcomes look like. You using it 30 percent of the time and look at your readmission rate is higher this number is where what's going on?" and sometimes we found that conversation is well you know my patient panel has a really high percentage of say chronic renal failure and we don't have the right dosing built into the pathway. And then within two weeks we fix the CPM and now it's there and sometimes it's more of an eye opening conversation saying oh my gosh I didn't realize that I wasn't using x. And so we then bring folks along and we have seen dramatic, Saul, dramatic changes in clinical outcomes as a result.

: What a great example Chris. Just thinking through this application you know I had a guest about a year ago we were talking about she's at the New School of Medicine, Nadia, who I'm putting this conference together the healthcare thinkathon. She talked about how innovation in health care is implementation and what you're talking about here Chris is implementing right away like not even waiting. You have the conversation you identify the gap and then boom you get to work.

: That's exactly right. When I think about implementation science and health care we've got still a lot of low hanging fruit in just knowing what the right thing is and finding as seamless an easier way to do it. And when you move from that place you begin with that foundation and start to turn a flywheel. Your caregivers then begin innovating and saying why is over here when it could be over there why are we having to file 13 different ways to do X when all we really need is one. And so by teaching folks continuous improvement by resourcing them to do it you begin turning an innovation flywheel that begins to then drive itself.

: That's so awesome. And folks I also want to give you a heads up so we're having a great discussion with Dr. Chris DeRienzo. He as you can tell is so in just deep into this subject of continuous improvement but overall improving patient outcomes. And I want to invite you to check out some of his thoughts. He keeps a blog. You go to drderienzo.com, you'll find his blog where you'll see much of his work. He's got videos on their blogs. It's just a wealth of his thought process there so don't miss that if you're a clinician or anybody in the industry looking to get better. I truly recommend this blog to you. He pours a soul into it and allow best practices. So definitely one to check out and we'll also leave a link to that show in the show notes that we'll share a link to you for as well. So Chris obviously some great things going on at Mission with what you and your team are doing. Can you share a time when you had a setback as a team or personally and what you learned from that. I feel like we learn more from those times and the successes.

: No doubt Saul. And I think one of our greatest successes being the CPM work. We also feel that in almost every possible way you could without impacting patient harm or regulatory failures. And so as we walked through a driving CPM work we took way too long at the beginning. My chief quality frame to Tory Dr. Darrell I think compares it to the gestational period of an elephant which is something like 600 days or taking a year year and a half to get these care process models live. We were biting off way more than we could chew at the start and we were winding up with 80 to 90 page documents which were filled with great practice but were not usable and so we learned from that mistake. We didn't have the right folks on the team. We didn't ensure that those who would be using the CPM were the same ones developing we didn't protect the time right for people who were engaged in it to really focus on this work and as purposeful a way as they could and so we made lots of mistakes and in healthcare as long as you've defined the box to avoid your mistakes reaching patients and causing harm I think we need to be comfortable making mistakes on our continuous improvement work because the best innovators are going to make mistakes. And unless you're making those kinds of mistakes you are within a safe boundary. You're never pushing hard enough.

: I think that's such a great column Chris and you mention that documents got up to 90 pages what did you guys get it down to.

: So we've improved from there. We still have eight to ten page documents with references for folks who want to review them but now we actually have just a video walk through now how to use the pathway and then a demonstration in the analytical portal of how to measure that utilization and as you imagine utilization has dramatically increased when you make it much easier to learn how to use it.

: Wow that's outstanding. You know it's eight to nine pages of video from ninety pages. Huge kudos to you and your team, man.

: Well again I can't take much credit for that. That's turning it over to the team and saying here's what our goal is. We need to work from getting one of these live every 45 days to one every 10. And the why is because as our state moves very purposefully into treating populations we need to be prepared as a health system to meet that need. And we knew three - four years ago that we weren't there and that it was going to take a getting 30 to 40 of these care process models life each and every year across subspecialties, inpatient and outpatient ambulatory and post acute. So when we sat down with the team and said what's it going to take to get there we had to totally redesign the document totally redesign the EMR workflow. We had to totally redesign the approach in the analytics environment - moving from perfect solutions to 80 percent solutions and then creating incremental improvement from there. And so it was that kind of teamwork and then some momentum as we started the very first one. Gosh I want to say it was like November 2016 and Dr. Dauer actually took ownership of it herself on the ambulatory side and put a win on the board and folks could see wow. No one believed we could do these in 90 days. And all of a sudden there's proof. And that one it was copd exacerbation. That one alone Saul has prevented emergency department use it's prevented inpatient hospitalizations and saved on the order of 200 thousand dollars a year in direct cost.

: Huge. That's so awesome and you know so kudos to you guys for really putting the right team together and just getting it done and you know Sir Richard Branton once said It takes a true expert to simplify anybody could complicate things. And there's no doubt in my mind folks listening to this that Dr Chris DeRienzo and his team are experts at what they do so if you wanna learn more about them again check out Dr. DeRienzo's blog where you could find a little bit more about him and the things that he's up to. So what would you say your proudest medical leadership experience is to date, Chris?

: Oh Saul, there are many. I have been really fortunate to be a mission for four years working with some spectacular teams. But one one early win that I had I'd call out. I remember it was a couple of years ago and we had just begun really the socialization work of building our culture of continuous improvement that would be grounded in data analytics that I had spent a lot of time with various clinical leaders showing them dashboards and pitching the story as to why this mattered and how it could serve to improve the work that they were doing. And I remember one day in a meeting one of those clinical leaders without any prompt just pulled the dashboard up and started driving it himself. And I thought to myself oh my gosh this is the tipping point. If Jeff can pull this up in a meeting be confident in the data use it to make a point and drive it home then I know that we have crested that hill of acceptance. And we're only going to keep driving from here. And that was like three years ago and I'm just incredibly proud of how far teams have been able to come with that since.

: That is amazing. And what would you attribute the uptake on because a lot of organizations do struggle as you know, Chris.

: I think there are a couple of things. First as we started our work in analytics and we began with what was most core to our mission which is the bigger aim to get each patient to their desired outcome first without harm, without waste and with superlative experience for every patient family and team number. And so beginning in that space speaks to the core of who we are. And so it got to the Y right. If you begin notes why then it is much easier to explain the House and the what's that springing out of it. It's about beginning with why because we need to dramatically improve the health of the population we serve developing tools then didn't become just shiny objects that sat on a wall. They became the house to delivering on our why.

: That's so cool that's so cool and yeah just again a reminder listeners we've got to keep that why front and center, find ways to weave it into the culture of your organization and that message got to come from the top all the way through the organization and that's how we make outcomes better. Tell us about an exciting project or focus that you're working on today, Chris.

: Yes it's springing from the same why. One of the things I'm most passionate about right now is the ability of using technology in much smarter ways to scale humanity in healthcare. And so our first data science project that's bringing a machine learning model live into the clinical environment is around readmissions predictor. So we have terrific teams of transitional care managers whose role it is to screen through lists of patients who are discharged and figure out who do I need to focus on today and how can I keep them home and healthy and not be readmitted to the emergency department or the hospital. And that is an incredibly challenging job and it's a job that impart only a person can do in that you've got to figure out what do I do for this person. But who to focus on is a problem that machine learning can help solve. So our spectacular data science team led by Dr. Andy Johnson spent months developing the machine learning model that consumes data every day about the patients who were discharged yesterday and serves a prediction at 8:00 o'clock in the morning to our transitional care manager team on who is most likely to be readmitted and why. And what that does as we've iterated and continue to improve the user interface and continue to improve the model itself is allow our care managers to spend less time hunting and pecking for information that tells them who do I need to focus on and scales the time that they actually get to spend focusing on patients. That's what they went to school for. That's what brings our caregivers joy. If you ask any unit, any clinic, anywhere at Mission we've done it a hundred times. What brings you joy. The answer is spending time with my patients spending time with my team. And so the more that we are able to scale opportunities for our caregivers to be with patients and connect with their teams the happier they are the better outcomes we're going to get. So I'm super excited we're now six months into implementation. We've gone through multiple, multiple waves now Vater of improvement aspect will keep doing so for the next six months and I'm confident this will become a core part of the way that we approach readmission prevention moving forward.

: That's awesome. Chris congratulations to your team for that. And you know it's a great example of how staying focused on the why and the specifics of what your organization is up to that you can actually use tools like machine learning to augment the work that humans must contain to do.

: Amen to that.

: Getting close to the end here. Let's pretend you and I are building them medical leadership course on what it takes to be successful in medicine. The one of Dr. Chris DeRienzo. We're going to write out a syllabus - four questions followed by a book that you recommend to the listeners. You ready?

: We'll go for a man. I've listened to lots of these and so I'm hoping it's lightning fast as the guests.

: I know you're going to kick butt. What's the what's the best way to improve health care outcomes?

: Focus on getting better. I think that we constantly fear perfection and we've got to focus everyday on just be better than yesterday.

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

: Fearing making mistakes.

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

: You need to continuously improve.

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

: It's our mission if we return to the Y which is our big dream. What we do next is never in doubt.

: Love that. What's your all time favorite book, Chris, that you'd like to recommend as part of the syllabus?

: Oh my gosh I've got so many good ones. I think on the leadership side every year I return to Colin Powell: It worked for me because there are just so many solid lessons in leadership that every year that I've been in a leadership role I wonder rereading it and getting some other kernel of good learning out of it from just totally off base book perspective. I just finished reading River of Doubt which was about Teddy Roosevelt's journey down an unknown River in the Brazilian rain forest. And you want to talk about sort of exciting an adventure that was a kicker.

: Wow that sounds super interesting. Two amazing books both haven't been recommended before. So for the listeners take those down and check them out. All the things that we discussed today are available at outcomesrocket.health/derienzo You can find that there links to this podcast links to the show notes, as well as a full transcript. Chris, this has been a blast. Really appreciate you spending time with us before we part though. I love if you could just leave the listeners with a closing thought and then the best place where they could get in touch with or follow you.

: You got it man so I think I'm just so grateful that you're providing this kind of a platform for folks across health care to engage with each other. You know I think that increasingly as healthcare evolves from being a field in which we engage with people episodically in different settings for walls to continuously throughout their lives we have to be thinking fundamentally different than we did yesterday because our solutions for yesterday are not going to solve problems of tomorrow. And so I think that the foundation that you're creating here the platform for folks across industry vertical and horizontally to get together to talk to each other and to spark ideas is just spectacular. And so you've mentioned my blog. I really appreciate you noting it there are there links to follow me on Twitter and on LinkedIn there as well. And always happy to engage with folks who are committed to continuously improving the way that we deliver health to Americans across the country.

: Outstanding Chris. And again listeners the blog is drderienzo.com. Chris it's been an absolute pleasure and we're really looking forward to keeping up with your success and the things that you do for our industry so keep up the great work and thanks again for making time for us.

: Likewise, Saul. Really appreciate it.

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Recommended Books:

It Worked for Me: In Life and Leadership

The River of Doubt: Theodore Roosevelt's Darkest Journey

Best Way to Reach Dr. Chris:

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Unique Approaches and Lessons in Population Health with Corbin Petro, President and CEO at Benevera Health

: Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. Today I have Corbin Petro. She's the President and CEO of Benevera Health. A technology enabled health services company focused on population health and person centric health care. These are buzzwords that you all have heard on the podcast. Population health being one of them being focused on the care of populations versus just a single point of care and then person centric health care taking care of that person consumer centric health care is really on the cusp of the changes that are happening in health care. She created this from a payer provider joint venture Benevera a health provides tools and resources to support value based care including analytics, risk and Insurance strategy and locally based care coordination and patient engagement services. Prior to that she was a Chief Operating Officer of the Massachusetts Department of Medicaid Mass Health. A 13 billion dollar agency providing health care to one point four million Massachusetts residents. She oversaw operations at t function several program areas and helped develop new value based payment and delivery models so as you all can see and hear she's no stranger to value based care and to the cutting edge in what's happening to health care so it's a true pleasure to have you on the podcast, Corbin. Thanks for joining us.

: Thank you Saul. Appreciate you for having me. It's good to be here.

: Absolutely. Now is there anything in that intro that I left out that maybe you wanted the listeners to know about you?

: You know I mean that was a great overview. I think broadly My background is pretty unique and I've spent my career my entire career in health care but spent time in both the public and private sectors in consulting as well as being an operator and focused on innovating in multiple segments payer provider services and so I think you know with this lens I have a pretty unique view of the healthcare ecosystem.

: Oh without a doubt. You know and everything is so siloed and healthcare that to have somebody like you Corbin that has seen and tasted the way things roll in the different silos it's hugely valuable. And so I'm just curious you know a whole career in healthcare what got you into the medical sector to begin?

: Well for me it's really two things. The first one is why I was drawn to healthcare in the first place and then the second is more about how I think about having an impact in healthcare. So you know the first reason to start, I grew up just outside of Cleveland Ohio in a family that valued hard work and public service. So my father was a public servant. So it's really the service side of health care that attracted me. You know there are a few years growing up where my family went around the state talking to people of all walks of life to understand really what they needed from government. Ohio has 88 counties. The majority of which have a county fair and you know one summer I remember going to something like 75 county fairs.

: Wow, in one summer fall in one summer?

: Yeah.

: Wow, amazing

: So you know talking with people who have different backgrounds needs and economics was really striking to me. And health care is really the ultimate equalizer it's something that impacts all of us at some point. And I was struck early on at how different the experiences can be across people. So you know health care as a service fans you know across both public and private sector that affects all people regardless of background is really what I was drawn to. The second part is more around where I thought it could have impact within health. So I was an athlete growing up I was a distance runner in both high school and college and as an athlete how I performed in a race wasn't driven by one or even two things. It wasn't just my genetics or my training or my diet or what I ate the night before or how having my lucky socks impacted me mentally or the fact that I could afford the best shoes. It really a combination of all those things. So you know health care is the same way and as a former athlete I'm always surprised at how we address it through just one or two aspects. So you know my mission and focus in health care is through the service supervised by acknowledging the span of factors that can support oneself.

: Love that very very thoughtfully approached, Corbin. And you know I think it's fascinating right. You spend that summer going and seeing these different fairs and I think one of the things that we need to do better in healthcare is get that feedback from customers, our patients and listen better. And I feel like that was an advantage that sort of you formed very early in your career by doing that. What kind of impact would you say that summer that you did had on your formation as a leader today?

: Well I think you know understanding that people have different perspectives and different experiences and particularly in healthcare how those can now percolate to the top in terms of what somebody is thinking about and what's impacting their day to day lives. I think all of that in sort of that broader perspective helps me be a leader and a manager but also helps me and in the view that I have toward healthcare.

: For sure. That's interesting. So there's obviously a lot to tackle within the sphere of healthcare Corbin but today what would you say a hot topic needs to be on every medical leaders agenda and how are you guys addressing that?

: Sure, well, you know you talked about barriers and silos and a big part of my career has been breaking down traditional silos whether that's data organizations or how we think about patients. One example is when I was working as chief operating officer of Medicaid in Massachusetts one of the things we did was launch an analytic tool to help us identify waste and abuse a tool incorporate data from a bunch of other state agencies. So it gave us insights into a person or organization or a physician's activity with the state. Well outside the walls of the Medicaid agency the fact that data between the Department of Revenue and the different aspects of state government wasn't shared with so shocking to me. They didn't have a single record for a person a citizen of the state. But this is really how data exist everywhere. It's not like Amazon is sharing their data with with Walmart. We think about how important data is and analytics but it's always within sort of a siloed sphere. So in healthcare I think it's really important that we recognize that a person's health and the data associated with it shouldn't be siloed and so that definitely goes for the way we think about treating patients and what we're doing at the end of era. So everything we do at the end is about breaking down those silos and just mention data. And that's one area where we're certainly innovating through our model. We bring together that's the claims data from the insurance partner and we integrate it with EMR data from our provider partners and then we bring in publicly available data and patient report data have to have a really rich picture of the patient as well as a provider behavior. So I think it's important in healthcare for us to think about the service and the public aspect of healthcare as something that impacts everyone and how we can work together to improve health more broadly we shouldn't think about data like Amazon or Walmart and think about hoarding it for our own benefit. We should think about it as as a means to improve overall health.

: I think that's a good call out Corbin and you sit in a unique seat as leader of of an integrated payer provider system. So you see a lot from both sides of the aisle that maybe a lot of companies don't see or allow hospitals and a lot of insurance companies don't see the full picture. Can you give an example of how you guys have done things differently to create results and improve outcomes?

: Sure. I mean I think our model itself obviously is very unique. So there are basically two major innovations in our model that that involve doing things differently and breaking down those those silos I mentioned previously. The first is is on the insurance side. So first part of end of era is the insurance aspect so what we did and the joint venture is took Harvard Pilgrim who is the insurance partner their market in New Hampshire and put it into the joint venture so that the hospital partners are owners of the insurance business. So in being owners of the insurance business and sort of blurring those lines between payer and provider it really allows us to learn more from the hospitals as what are the sort of the pain points and the community needs of their communities. So that helps us to develop different products and services that the community needs as well as what you know understanding those physician pain points so as an example our hospital partners told us early on that some of their challenges with high deductible health plans was that the patients weren't paying their patient portion the you know the coinsurance and deductible and that really encouraged us to move more toward transparency and point of service pricing copays for example and to build products that limited the patient cost sharing specifically for our partners. So really let them focus on delivering care instead of going back and capturing the financial piece from patients. That's sort of on the insurance side you know the second part of our model that we've talked about was spinning out a new company doing tech enabled services focused on population health and again we sort of break down the silo by sharing data across parent provider obviously giving us a really rich picture of the patient as well as a better understanding of how providers are delivering care. We think about patients holistically and try to address all their needs through our engagement model whether that's housing or helping them understand insurance, scheduling appointments, transportation, scheduling visits. Understanding how to manage chronic complex conditions and then for providers we're able to have real and local benchmarks that they trust to help us identify outliers. So those are sort of the ways that we're innovating and in terms of outcomes quantitatively are our results have been pretty fantastic. So you know we've had significant reductions in E.R. and inpatient missions that drive about a 35 percent reduction in costs for patients who are engaged in our program. It's about four times or why those are sort of the quantitative results. But you know the real results are brought to life by some of our patients physicians stories.

: Yeah that's really wonderful. You guys are definitely so focused on moving the needle there for patient care but also it's so important to keep the eye on on the organizational business success because hey without margin there's no mission so it's super key. And a lot of hospitals are struggling to find new revenue models. And taking this unique approach is I think definitely opening up some doors for you guys as a system. But I'm sure with that comes a lot of lessons learned. Can you share with the listeners a setback that you had and what you learned from it?

: Sure this is a great questions in many ways. Failure and mistakes are really just when reality doesn't meet expectations. So that can be because of unrealistic expectations it can be because of falling short or mistakes so that you know there have been many times in my life where reality didn't meet expectations and many of those felt like massive personal failures. But in my current role at Benevera we expected the hospital and provider partners in the joint venture to really sort of create a consortium amongst themselves learn from one another and for Benevera to ride services to them as a collective. And for the most part that just hasn't been the case. The market dynamics have changed dramatically in the area that we that we serve. So for example Elliott Hospital which is our second largest hospital decided to merge with another hospital that's not part of the joint venture. So you know the hospitals that we once thought would be we could see them aligning closely together started to have less and less reason to do so.

: Yeah.

: We also realized that the providers who are in our joint venture are in a very different place when it comes to moving toward value based care so Dartmouth Hitchcock is the largest hospital in our joint venture and you probably heard of them. There are large academic tertiary hospital with a lot of community group practices around the state of New Hampshire and they've been participating in Medicare ASIOs and are in many respects contract so they're well on their way to value based care. On the other hand Frisbie Memorial Hospital is our smallest hospital partner. There are 75 bed Community Hospital located in a part of the state where their patient mix weighs heavily on public programs so they have a lot of Medicare and Medicaid patients in their area and the joint venture is really frisbees first foray into risk and the first time they really thought about moving toward value based care. So those two polar opposites are really just examples of how our provider partners were in very different places and needed very different things so we sort of had to acknowledge that the consortium model is sort of serving them as a collective wasn't going to prevail. So we pivoted. So instead of serving all the providers together we started thinking of them individually and with their unique needs. At times it feels like a failure because you know I really wanted them to sort of think together as an elective and treat them as a consortium but in other ways you know we're able to add a lot more value in this model. Being a true operating and servicing partner to do are a different provider groups and meeting them where they are.

: Now that's super interesting and I appreciate you sharing that, Corbin. You know it's when you meet with the like you said right. When when reality doesn't match your expectations. You said it so eloquently and you guys have made shifts to adjust and give these providers what they need. And I think it's all about making sure that we pivot that we do the things that are are really being asked for us rather than sit there in denial and trying to do things because that's where things really hit the fan wouldn't you agree.

: No that's exactly right. I mean I think recognizing and pivoting when things aren't going as planned while balancing that with with patience. Right. So we know that in healthcare care things are very hard and change is hard and takes time and so knowing when to adjust course and when not to. I think that's really important and to sort of recognize them.

: Now that's a really good call and appreciate your walking us through that. So how about the other side of the coin, the positive. What's one of your proudest experiences or moments that you've had to date with your work there?

: So the teams I've I've been a part of building and the impact we're having on people's lives makes me proud everyday in the work that we're doing. The team at Ben is mission driven smart thinking practically about how we can innovate and improve the lives of patients or our work every day I hear amazing stories from my team and that makes me so honored to be working with such amazing people. But sort of on that on the team side when I when I moved into my role as a CEO it was you know was my first time reporting to a board and generally just being a CEO and I wanted to be successful and I knew I had a lot to learn and so I asked my board if they would support an executive coach for both me and for my team. It was a big ask. At the time since you know a required investment early on but once they agreed to it I was so proud to be able to support the development of my leadership team and you know we all benefited personally and as a team from the investment and personally I see it as one of the most valuable leadership development activities engaged in and I know that the folks on my team who were able to engage in and with the executive coach feel the same way and so I'm proud that I have brought them into the fold and was able to develop them in that way.

: I admire you for that, Corbin. A lot of times people believe that they've got to know everything, that they've got to just fake it till you make it and that couldn't be farther from the truth. In I'm a big proponent of coaching too I've hired professional coaches to help me through my journey. And I'll tell you what it saves time, saves money and it really helps provide that guidance that I feel like we all need especially as leaders in healthcare so kudos to you for not taking that mindset that hey I got to find a way and fake it till I make it. Because that really I think is what makes a big difference in a leader in today's healthcare environment so congrats to you on that.

: Thank you. Yeah. No I think you're right. I think we're always there is a bit of sort of fake it till you make it. Of course. But I think it's important to acknowledge where we have weaknesses and where we can grow. And I'm certainly a believer that you can constantly be learning and growing.

: Totally. Now tell us about an exciting project or focus that you guys are working on today.

: Sure we'll sort of in that that same growth mindset sort of trend. A big part of our work is continuing to just change and improve on a day to day work that we're doing engaging with patients leveraging data and technology and working with providers to move toward value based care. So we're constantly just improving our technology how we're using data how we're using all of our technologies to improve how care is delivered you know on the patient side we're working to integrate new data sources into our analytics and reporting back so that our analytics and algorithms are constantly learning and providing better identification and recommendations. We're also launching new ways to engage patients including web and app based tools to extend the work of our very human based teams. But on the on the provider side which is where we do a lot of our work helping providers move toward value based care we have a renewed effort right now around working with providers on identifying low value care which has a negative impact of quality outcomes and obviously is a big waste within the broader healthcare ecosystem. So in one example we looked at some basic diagnostics, imaging and pharmacy. Those three areas are areas that we know from literature often overused and prescribed. We've got a lot of outliers but in one example there was an endocrinologist who was prescribing high end diabetic medication significantly more than his peers within his organization and at surrounding hospital system. So he was like three to four standard deviations above the mean. We showed this to the Chief Medical Officer of the system and she looked that and was ready to have a conversation with the doctor on his future age and the potential negative impacts. And he embraced the conversation and actually changed his behavior. So in this case it was really at the local unreal benchmarks that we have and that we use with our partners finding sort of actionable efforts within that data and then having real live conversations with providers that really lead to impact and you know it continues to be something that we're focused on today is sort of looking at that low value care identifying actionable efforts and things that we can do and then delivering that to our partners.

: Corbin I think that is so valuable. What a great story. Firstly I was recently doing an interview with Marcus Osborne. He's the he's the V.P. over there at Walmart for healthcare. And you know the big thing that he brought up like you're bringing up right now and it's a trend. It's like we're not giving our physicians the necessary metrics that they need to get feedback on whether they're doing well or are not as well as they could be or maybe overprescribing or under utilizing resources. And I think these metrics that you're setting up internally are so key. And the next step to helping providers get that feedback that they need to deliver better care. I mean there's not a provider out there that wants to do a bad job everybody wants to do a good job. And folks pressed rewind on this because I think that was a great story that Corbin shared and some best practices that leaders definitely need to uptake. Lots to be learned here from Corbin Petro. Corbin, this is coming to an end. Time flies when you're having fun let's pretend. You and I are building a medical leadership course and what it takes to be successful in the business of medicine. The 101 of Corbin Petro. I've got four questions lightning round style for you followed by a favorite book that you recommend to the listeners you ready?

: Sure. Let's do it.

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

: I think you're gonna like this one, Saul. But breaking down silos

: Love it.

: And working together so in most cases we have everything we need to improve outcomes. We're just not using what we have effectively because of access to information and misaligned incentives so you know in our case turning once adversaries, providers, and insurers with misaligned incentives and to advocates for the patient that's really near term I think the best way to improve healthcare outcomes.

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

: So we all know health care is pretty complicated so I'm not fully understanding all the different dynamics and players in health care and not thinking through unintended consequences. So you talked about consumerism a little bit earlier. So for example one of the challenges and consumerism of healthcare is that the patient for the targeted consumer has historically not been the one making purchasing decisions nor are the vast majority of people thinking about their health care all the time. So you know as we know the usage of digital apps and tools has for the most part been pretty lackluster. So I think before innovating in the healthcare space it's really important to understand. Again all the sort of different dynamics and players within healthcare.

: That's such a great call out and for the entrepreneurs or even you know large companies looking to innovate in the digital space. A big note to take there. How do you stay relevant as an organization despite constant change?

: So you know I think having a growth mentality constantly improving evolving and embracing change and then hiring people with that same mindset is really critical. So at Benevera who we are today as an organization should absolutely not be who we are three to five years from now if we are we've failed. And I can you know I can relate this back to my time as an athlete. Never being satisfied with your last performance and constantly changing techniques, training, diet with the goal of constantly improving. That's really just critical to any organization but particularly in healthcare.

: Powerful. What's one area of focus that drives everything in your organization?

: For us really the patient - the patient as a human and as a customer. So we aim to address all of a patients needs that we can and to think about them and their complexity not just as a disease or as a condition. So I don't know if I've mentioned this but we focus on what we call the whole person in person and then more broadly as a as a joint venture about delivering patient care better together. So we believe that by working together we can deliver patient care. So everything we do is aimed at trying to improve the lives of people and we really stay focused on that work every day.

: What would you say your book that you recommend to the listeners is, Corbin?

: So I have I have a lot of favorite books. Most of your listeners probably want something health care or sort of improvement related.

: Whatever rises to the top of your mind.

: Yeah okay. So I love David Brooks' The Road to Character which really helps. Think about how we as people evolve throughout our lives and seek meaning and purpose in what we do. And so it helped me think about how who I was and what I was doing isn't entirely about intent and my own personal goals. It's also about where the world needs me now. So that's a really that book struck me at the time my life that I that I read it and then it just in terms of general reading. I love all things Michael Lewis, Haruki Murakami, and Kurt Vonnegut.

: Love that listeners we've had our great discussion with Corbin Petro today CEO at Benenera health. You could find all the show notes as well as a transcript of our discussion. Links to the organization links to the books that she has recommended for your learning. Just go to outcomesrocket.health/corbin and you'll find all that there. Corbin, this has been a blast. Really, really appreciate the time you've made for us. If you can just leave us with a closing thought and then the best place we're the listeners could get in touch with you or follow you.

: Sure. I'm gonna end with a little story about a meaningful experience that I had. So about 10 years ago I rode my bicycle across the country solo self-supported and self-guided. I started...

: From coast to coast?

: Coast to Coast, so yes.

: Good for you, that's amazing.

: I started in Seattle and ended in Washington D.C. and I covered thirty two hundred miles and 33 days so each day I would I would navigate my way through places I had never been and was able to see and talk with people of all walks of life. Most people thought I was crazy and they would gladly spend some time about their lives and challenges and everyday for me I had really high highs like reaching the top of the 9000 foot elevation and really low lows like you know when a state highway turned into a dirt mountain pass. So you know the challenges were physical and mental and often the really challenging parts were not what I expected. So for me not having physical contact with another human being for weeks at a time. It was really the only time in my life that I didn't hug another person for close to a month. Most of us have that human connection on a daily basis and it was really impactful the longing that I had for physical human connection. So my closing thought is that you know as humans we need human contact and especially in health care it's you know it's a very human endeavor. So technology can help us enhance but it really can't replace human contact. So as we think about innovating and health care. You know I encourage people not to lose sight of patients as humans and our need for human connection especially as we age.

: That's a great story. And pretty amazing that you did that and it does bring home the message you know the importance of care.

: Yeah absolutely. And I think you know it's obviously very striking for me and I think just continually thinking about patients as humans is a big thing that we try to do at the end of era. So in terms of connecting with me obviously check out our website Benevera health and then personally I have a very Google-able name only Corbin Petro who is out there. So I'm on LinkedIn and Twitter under my full name.

: Outstanding. Thanks again Korban. This has been a blast. Listeners. The beauty of podcasts is that you could go back and listen again. I know this is one that I'll personally go back and take more notes on. So you'll be sure to do the same thing and just want to say again Corbin, thanks so much for making time for us. Looking forward to staying in touch with you.

: Great. Thanks Saul. I had a good time. Appreciate having me on.

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The Road to Character

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How to Innovate Systems, Service Models and Products with Less with Geoffrey Gurtner, Professor & Vice Chair of Surgery at Stanford University

: Welcome back once again to the outcomes racket podcast where we chat with today's most successful and inspiring health leaders. Today I have Dr. Jeffrey Gertner with us today to chat with a little bit about health care that maybe you're not used to. Different angle on surgery as well as reconstructive surgery and startups. Dr. Gertner has a wide array of experience. He is a professor and vice chairman of surgery at Stanford University, a plastic surgeon by trade and also research scientists. He has a lab that focuses on translational projects that are developed in the lab and are commercialized to improve patient care. He's also general partner at Tautona Group where they lead and the development of new technologies for aesthetics reconstruction, room care, surgical and biomaterial devices. And finally he's founder and director at Neodyne Biosciences where they're they're basically an evidence based company developing and commercializing innovative tissue repair devices to minimize scar formation. Restoring both function anesthetic appearance lab topics that are of interest to you. So super excited to have Jeffrey on the podcast. Thanks for joining us.

: Thank you for inviting me I'm delighted to be here.

: So Jeffrey anything that I left out in the intro that maybe you wanted to share with the listeners?

: I think you covered most of the things that I do and it kind of them little bit guilty of a short attention span I found I'm a clinical medicine and have a lab and then also have tried to work in the private sector to bring you know new technologies and innovations to patients around the world.

: And it's super important work that you do. So I'm excited to dive into some of that in the podcast today. Why don't we kick it off with you letting us know why health care like what got you in the health care to begin with?

: Yeah it's a good question. I think I I again was looking at lots of different options growing up and certainly in college and medicine really stood out as I thought about it just because it had a piece of it that was business, piece of it that was more art than science. That piece that was science and that really seemed like for someone again who might be guilty of a short attention span. There were lots of different paths that you could travel as a physician and it seemed more like an adventure than a job. And so you know through process of elimination I kind of just decided that it was the exciting thing to go into and kind of have never looked back since.

: That's awesome. And you've definitely done quite a bit in the time that you've been in the field. Jeffrey if you had to zoom in to hot topic that needs to be on leaders agendas listening today what would you say the hot topic is and how are you and your different organizations you're involved with approaching it?

: Yeah I think you know just the the thing that struck me being an academic medicine in the private sector is just the real inertia of the medical system and the real challenges we have and not just in innovations in terms of therapeutics or devices but even in innovating changes in the systems and service models so that we can become more and more efficient and do more with less and just the natural frictional points that are kind of legacy parts of our medical system in the United States that are just really those kind of nimble innovation synthetically out here in Silicon Valley you see people disrupting gigantic industries left and right. And I don't think that's really possible in medicine because there are so many different stakeholders including the federal government that are involved in it. But you know it doesn't mean it's impossible and so I think just constantly thinking about how can we make the system better how we think about how to make the care of an individual patient better and trying to knock down those those barriers our least work within the system. I think it's kind of a job one for all of us what we're clinicians or scientists or entrepreneurs or executives or innovators. It's not a simple thing. So it has to be front of mind for us to be successful.

: Yeah Jeffrey I think that's a great call-out and I feel like the leaders in healthcare that have been successful at moving the needle are the ones like you that decide on a vertical and they just stay hyper focus. Now I know you like the kid around about hey you know I got a short attention span. But the thing that you've done so well Jeffrey is honed in to your area of specialty. And I just love that you've done that and that's why you've gotten the results you've gotten. I love if you could just share with the listeners how you've created results and maybe some examples through one of your companies or your lab.

: Yeah sure. You know it all really starts when I started with patients and just as you go through your surgical training in my case you kind of have this illusion if you become very well trained you're going to be able to solve most of the problems for the patients that come into your office. And as you go through your training you realize there's just a lot of things that we really can't even address. There's a lot of things that aren't evidence base that we do to patients. And there's all these unintended consequences downstream and so my whole point of evolution has been relatively organic starting with "How can I do a better job for patients?" and then at a certain point you realize what we have to come up with new approaches for some of these things and that we do to the laboratory and you get to a certain point in your in the laboratory and actually that's where I was in 2005 when I was a professor at NYU and I had Art in Manhattan and had all these things that I thought were good ideas. I couldn't figure out how to get them into the real world. It just wasn't. It's not what Manhattan New York City is known for. It's not yet that time there was certainly not a med tech startup culture critical mass. I moved to Stanford figuring you know one place on the planet really knows how to innovate it's probably this area and realized pretty quickly that know all my great ideas were actually not very good ideas and they were certainly they were not good businesses in any case I learn that that final piece of what makes the idea, a good business and how it can have all the stars align and so it's just been you know unfortunately kind of just dogged persistence trying to figure out how to make a difference and how to advance the field of medicine that really has as kind of always motivated me. And you know I think again if you have that as your primary focus then I think it makes it easy to do things that maybe don't make a lot of sense like going out and you know as a surgeon and pitching ideas on Sand Hill Road to venture capitalists. That's actually how you learn. You learn by realizing that what you thought were ideas weren't good ideas. More importantly like what is a good idea and not in a vat. And then you can move forward. So you know it's a very simple motivation for me at least and that has kind of ended up you know there was never a strategic plan that I wanted to be an entrepreneur and became an entrepreneur out of necessity because that was the only way that I could see things that might impact patient care getting into the real world.

: Now it's a winding road you know and it's pretty cool that you've taken it. You've been persistent with that and resilient for that matter and if you had to boil it down to the essence of what does make a good idea good business. What would you say the 1 or 2 things are?

: I think you know for sure it has to me. For me at least it has to mean an unmet clinical need. I think there are arguably good businesses that are need two sorts of things. You know again you know we see it now we're kind of the immunotherapy for cancer. I mean obviously a great idea but if you don't really have the lens of a physician that's a great business. So now everybody is flowing into that sector but there's all these other areas of you know unmet clinical need that don't have investment and so trying to keep your eye on what you know and so as you alluded to I kind of focused on surgery reconstructive surgery plastic surgery as I know that area. You just have to find different ways to innovate. So I think remaining focused on the unmet clinical need believing you know I think the second piece is really really really being sure that your data is rock solid. So it's always easy to fall in love with your ideas and kid yourself and that's just a waste of everyone's time and money because you don't want to spend six or seven years worth of technology that you were aren't pretty sure it's going to work in the real world. And then I think being persistent and creative there's many paths to the top of the mountain and figuring out which way to go when you're not in the hottest sector, you're not in immunotherapy for answer. How do you foster innovation in those areas. I think sometimes requires just dogged persistence.

: I think it's true and that's something that's hugely valuable and you as a leader Geoffrey and for the listeners that are in the middle of this process meaning to innovate to get their companies ahead to help patients to improve outcomes that dogged persistence is so key in what you're doing and take some inspiration from Geoffrey and his winding road and what you're doing it doesn't happen overnight. You've got to stay with it for the entire course. Geoffrey, you know just speaking of winding roads I feel like we learn a lot more from our setbacks than our successes. Can you share a setback that you had and what you learned from that particular setback?

: Sure yes. But ten years ago started a company that was based on. Again you know really exciting technology that we've developed in our laboratory and it is really focused on novel ways to connect blood vessels. So that's mnemonic technologies and those kind of a classic example of that you know saying is, "It's not what you don't know that tricks up it's what you know for sure that just ain't so". As Mark Twain said and that we went into it with the knowledge that there were lots of it was a way to glue things to get real hallow tubes together. We went into it with the knowledge that there were lots of FDA approved adhesives on the market that were being used clinically and yet indications that we want to go into they were commercially available and so we assumed that the thing we didn't need to innovate on was the adhesive piece. And as we went in our core technology that enabled the using of adhesive to connect 2 hollow tubes worked extremely well. I mean it works great. What we found was that for certain applications these adhesives were really not good are not great they weren't perfect. They certainly weren't adequate for anastomosis. So you know that was kind of a real eye opener that you really need to question all assumptions. And again these were things that again had gone through FDA approval had multiple publications. And as you kind of get into the weeds of how does this actually work in patients realize that these were imperfect things and if we had known that ahead of time we would have certainly saved ourselves you know a lot of time and it would have changed kind of our assessment of the value proposition and also the risks of that thing. And so you know now as I look at projects I obviously look at every assumption not just the ones that incur risks.

: No, that's such a great call-out. You know and there are a lot of things that we could get into and we assume and I think it's a great call-out. And I love the quote that you shared. It's what you know for sure. That is so that it really isn't us. I love that. And that was Mark Twain right?

: Yup.

: What a great quote. I'm gonna definitely have to look that one up after this and keep it in my in my quote arsenal. Because it's so true and a lot of and a lot of us in healthcare well and we mean well and we work hard and we're focused. Don't let these assumptions ruin your work. And the benefit that you could be providing the patients. Thanks for sharing that that's really insightful Geoffrey.

: I'm sure. Yeah. And I think it's corollary is kind of why arrogance I think is a real, real negative for people that want to innovate because again assume that you know you know things are your confident you know things that I think you really have to have that can a learner's beginner's mind at all times to avoid essentially you know stepping into a pothole.

: Love it. That's so true. So you walked us through sort of the some of the shadows with that company. Talk to us about one of the proudest leadership moments you've had to date.

: Yes. So one of our one of my companies is Neodyne Biosciences and it's started actually when I was an intern at Mass General while working at the Boston Shriners Hospital in the 90s. Take care and burn patients and just realize again that was a situation where all the care is free. All technology was available and you just realized that these kids who had these terrible burns that literally were skin deep we could keep them alive. But you know their lives were immeasurably changed irreversibly changed just from that one moment. And there was nothing I could do as a surgeon. There is no technology that was out there that could change that. And so that kind of we embarked on a lifelong kind of project understand fibrosis and scar formation and really has been the focus of our laboratory. And you know one of the companies spun out of based on our understanding of one of the key determinants as a surgeon we know that mechanical forces are critically important in how a scar heals. We learn about these lines of minimal tension we're taught to orient our incisions so that they don't cross or that they are parallel to those lines with the clinical kind of anecdote that your scars will be better if you do that. And so there's you know again that that kind of thing that again was outside of surgical disciplines was not well embraced certainly when we started working on the mechanical environment how it changed fibrosis and scar formation. And to test that you know we actually did a human clinical trial with a little device that actually changed the mechanical environment and used incisions in humans and found that you could decrease the scar formation about you know 90 percent. Based on that. And originally we were just going to go and start screening drugs. But someone said Hey why don't we. We could use this device and people can make their c section scars or their knee replacement scars better and so we started a company that is Neodyne Biosciences is now and has treated basically using the experimental device it's now much slicker and has branding and all the rest of the stuff you need for commercial device. But it's true that 50000 patients are Serena Williams as kind of our our celebrity endorser. And you know it has made this reading those kind of testimonials on real self or different kind of social platforms seen how many different patients you know women who've had c sections and things like that is very gratifying and that's something that you kind of developed in your laboratory know has an impact on so many patients. But the journey is not over because obviously we feel that those sorts of devices don't help to earn patients and so we're now actually doing the thing with you know small molecules to block fibrosis for burns and so it's kind of again very gratifying that something where you saw an unmet need can impact and chip away out of it. And hopefully you know that pursue your career really change the game for fibrosis and scarring in a variety of different disease states.

: What a great story Geoffrey. And it kind of all goes back to that beginning where you sort of you called it an illusion that you get the best training and you're going to be able to solve everything, you get out and you realize that that really isn't so. And sort of that that's the genesis of all the wonderful things that you've done and now you've uncovered a lot of Pathways to help this reconstructive scarring area. And you as you work to identify a solution for those kids with the Burn Burn kids. You're finding other things and you're sticking with your pursuit to find that need. What keeps you going man. Like what is it that that keeps you in the game. Because you could have given up a long time ago?

: I just I think it's I mean I think that's why for me at least it's important for me to keep doing clinical medicine at some level and by far not the busiest surgeon but I still do surgery I still see patients and I think it just kind of rubs your nose in kind of how little we know every day. And for me it's those patients and just how do you move the ball down the field. How do we make things better. How you know in a hundred years how will medicine be different and hopefully better. I mean I expect it will be better through people just you know making incremental improvements all over the place. And I think now a lot of times especially as healthcare has become its own industry we can't put our blinders on and just go about our viewed generation or about this robot that are gaming the Preski any sister or whatever it is. And I think what you lose are what sometimes is lost is that holistic approach of hey we're trying to help one patient at a time by doing that we're going to advance medicine and by doing that, the world's going to be a better place. And so I think it's very I don't know exciting to be a part of. And you know just really for me it's I can't imagine not doing that I don't know when I would be that would have anywhere near the interest or urgency or meaning for lack of a better word than doing that and being part of that struggle and part of that that effort.

: Now for sure. I appreciate you sharing that. Yeah it's definitely true, right? Listeners, we're in this together and there's no one person is going to be able to solve all of healthcare's problems. So think of it as as a collective work and keep yourself in the game. You're not the only one struggling to get these solutions out there. You have other Brethren and sisters out there doing the work like Dr. Geoffrey Gurtner. So tell us about an exciting project our focus that you're working on today Jeffrey?

: Sure. You know again we're not only working on the process of fibrosis and scar formation but we're working on the the flip side of that coin which is you know core healing like in diabetes and aging and so we have lots of really interesting projects in the laboratory at Stanford we're fortunate enough that started a large clinical trials unit and our wound care center where we're actually able you know very rapidly. Look at what works and try to you know bring in an ethical responsible way bring new treatments to the market. So we're very excited about you know one of our projects that potentially can prevent wounds from occurring not just heal them faster and so we're we're gearing up for kind of initial clinical experience but that's you know I think an exciting and exciting effort and you know is kind of the flip side of the fibrosis and scar formation issue.

: Fascinating love that you're super focused on that and you know what. I know that your work will continue to yield benefits to patients that need it so keep up the awesome work. Getting close to the end here. Geoffrey, let's pretend you and I are building a healthcare leadership course on what it takes to be successful in medicine today. The 101 of Dr. Geoffrey Gurtner we're in our right at a syllabus. I've got four questions for you. Lightning round style and then will conclude the syllabus with a book that you recommend for the listeners, you ready?

: Yup.

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

: I think to always keep your eye on the big picture of we're in this to advance the care of an individual patient and to progress medicine?

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

: I think expecting the future to be like the past to expect good things that worked in the 80s and 90s are going to be the way the health care system broadly writ is going to be for the next 50 years.

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

: I think it started off by talking about the inertia and the friction that exists in virtually every vertical and horizontally across the whole system and I think although it's difficult to be nimble to always try to be nimble and have one of your aspirational goals to be nimble and you know rapidly changing organization that is not a hold into the past. And you know legacy sorts of systems.

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

: I think the patient you know just always whether you're a scientist, whether you're a practitioner, whether you're an executive thinking about improving the care of patients either by developing new technologies by providing the existing evidence base standard of care in the most efficient way possible. I think making a patient. I think sometimes we get tripped up with the you know the different billing in compliance and everything else. I think that patients should always be front of mind for every one.

: Love that. What book would you recommend to the listeners?

: So it's kind of an old one and I actually just had my 15 year old son read it and he responded well to and I thought he might just say boy this is really really outdated. So Zen and the art motorcycle maintenance is I think a great book because it kind of on the one hand is very very pragmatic it's the story of a father and son. And he expands from that sort of story into the big philosophical questions that have that humanity is pondered since antiquity of what is the meaningful life. What's the good life and you know at a really high level. So for me it's if you kind of are looking for meaning and that has practical implications I think it's a great book.

: Love that recommendation. Folks if you want to get all of the transcripts, shownotes, links to the book, Zen and the Art of Motorcycle Maintenance and all the other things that we discussed today just go to outcomesrocket.health/gurtner, G U R T N E R, and you'll find all that there. Geoffrey, this has been a blast I've really enjoyed the conversation. I'd love if you could just share a closing thought. And then the best place for the listeners could follow you or get in touch with you.

: So I think you just always keep the patient in mind whenever you do and be persistent and avoid arrogance not because arrogance is a bad thing. Arrogance is impedes your ability to be successful. And I'm on LinkedIn and Twitter and Facebook. So just as Geoffrey, G E O F F R E Y, Gurtner, G U R T N E R, and happy to continue in the conversation.

: Love it Geoffrey. Hey this has been a pleasure. Appreciate you carving out some time with us and looking forward to staying in touch.

: Thanks again for interviewing me. Appreciate it.

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Recommended Book:

Zen and the Art of Motorcycle Maintenance: An Inquiry into Values

Best Way to Contact Geoffrey:

LinkedIn: Geoffrey Gurtner

Twitter: @GeoffreyGurtner

Facebook: Geoffrey C. Gurtner

Episode Sponsor:

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