Category: Value-Based Care

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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

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 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.

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:

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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How to Strengthen Your Corporate Message in Healthcare with Ben Fox, Communications & Public Affairs Executive at GE Healthcare

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 racket podcast for we chat with today's most successful and inspiring health leaders. Today I have Ben Fox with me and we're going to be diving into some of the concepts of communications within healthcare. Things you got to consider and things that you should be thinking about. Ben is a senior director of Global Communications at GE healthcare. He manages two verticals. One that does nine billion and the other that does five billion dollars in business and his focus and his career has has been in communications for a long time external relations. And it's a pleasure to be able to touch base with him on this area focus so Ben, it's a pleasure to have you on.

Pleasure is all mine Saul, thanks.

Absolutely. Now did I miss anything in that intro that you wanted to share with the listeners?

Not really it was a very kind intro. I think I'm really excited to join the podcast today. I look back at sort of my own listening entertainment choices over the last five years and I would say podcasts have slowly risen up the charts to the point where in my daily commute I seldom turn the radio on anymore. It's mainly just podcasts back and forth there so I think this is a medium that meets demand and one that obviously is growing right now.

Yeah totally agree with you Ben. And I mean nowadays you can choose what to listen to and radio you sort of just get spoon fed whatever comes out. So I couldn't agree with you more. So you could have done communications and any area but you decided to focus on the medical sector why did you decide that?

It's a little bit of a roundabout story saw I would say one health care is in my DNA. My mother, my father-in-law, sisters, they're all nurses all in health care and I never really felt pulled into the clinical side of health care. I would say I feel very fulfilled and very purpose driven to be part of the industry and just a few steps away from that patient care that my relatives are in. But no I didn't really go to school planning to be in health care communications after grad school where I majored and got a master's in international relations. I jumped right into political communications and part of that was dealing with the Department of Health and Human Services and the equivalence of the state level where I served. But long story short After that stint in political comms I jumped into health care at GE Healthcare here and have been here for seven and a half years.

Amazing. You had quite the ride over there. Ben, you've seen a lot of the innovative approaches and sort of the ride that you go on when you're with a large medical device manufacturer like G. But when it gets to communications, I feel like there's a lot of common denominators whether you be a provider whether you be a med device company or pharma or digital firm for that matter. I love to hear your thoughts on what you believe a hot topic within communication needs to be for the listeners. What could they do to do a better job of their communication?

It's a very good question I guess to answer that. I'll start at the macro level and then work myself down to sort of a more personal micro level and I'll start with the cliche and that cliché being I'd argue that health care as an industry is still very much stuck in silo mentality. It's not a new argument. I think when you look at the pain points in healthcare as you've talked about on your podcast before Saul. Unsustainable cost increases, lack of access, EMR, EHR integration, destroying and care plans when it comes to diagnosis or treatment or planning. That's where the opportunities in healthcare. Basically, a disconnected healthcare industry. That's what GEhealth care here we call that precision health and that's sort of where we're moving in the future and simply put I would call, I would describe precision health as ensuring that the right actions are taken at the right time for each and every patient and that enables better cost of better care over cost. It enables better care for more people and enables better care in a lot of different care settings. Maybe some that were not completely used to. I think that means also connecting across the care continuum. That means going from diagnosis to treatment to monitoring it means mixing merging biotech medical imaging were GE health care plays really strongly and monitoring tools. So that's your hardware or your software and even your wetware sort of the data and your DNA all in one smooth sort of pathway, no silos that's the cliche. I think granular invading down a little bit. I would say personally I look at the way I interact with my bank maybe my insurance company and my realtor even how I go about traveling. What I do for entertainment. You know all that over the last decade has completely shifted very obviously for many if not all of us. It's all digital now. It's all at the touch of a button. Honestly my phone does more than my first computer job ever did. It's incredible but then you get into the health care experience and too often not all the time but too often there's still you know not taking on an actual pieces of paper. There's disconnection. There's paper forms as waiting rooms there's mysterious delays and questionable costs. There's even bureaucracy. I think healthcare is ripe for change. It's a common argument against seeing it my own life. I would say that's sort of the hot topics that GE Healthcare and others obviously are looking at.

For sure couldn't agree with you more. There's definitely some big opportunities to drive an end and make it better. And Ben what would you say right now as an example of what you and your organization have done to improve outcomes and do things differently?

That's a question a PR guy like me loves. I could probably talk for a straight hour about this. You know I can think of pocket sized ultrasound that GE Healthcare makes that help makes medical diagnosis more convenient faster more accessible to every corner of the globe. I could talk about our new mammography offerings which actually put a remote control in the hands of patients and help sort of address some of that discomfort that mammography is often associated with. What I think I want to focus on one and it's a fairly new one and it's called what we call here at GE the command center and it gets back to this idea of challenging the silos in healthcare that we talked about earlier. So set the stage a little bit for these command centers first understood fact U.S. and even international healthcare systems face massive challenges when it comes to cost, access, chronic diseases aging populations, et cetera. And if you look at finding ways to address that challenge improving the efficiency, part of the challenge there is congestion in our healthcare system and specifically congestion in hospitals and health systems, traffic jams to put it bluntly. no what some of the leading health institutions are starting to do and is partnering with many of these is look at transforming how they take these traffic jams how they manage these complex hospital processes and basically redesign patient flow and create and integrate a predictive command center. I think of it like sort of a NASA control room and we've all got this idea of sort of a massive room. Houston we have a problem where you've got hundreds of monitors hundreds of screens with experts there on-call to address basically the biggest questions of the day. Now John Hopkins, Johns Hopkins is doing this with GE right now. And they did it's interesting results already their emergency department bad assignment. One of the traffic jams they were having has been reduced since we put in this command center an actual physical room to address this and they've also seen hospital occupancy admissions. All those are getting better. Now patients I would say just make the point that they don't necessarily see the impact of a command center. They don't walk through it on their tour. They are going through the Edye or come in for a procedure. But they feel the impact and they feel it because the team working behind the scenes gets them into the hospital faster gets them in the right bed faster, gets them the right treatment, the right appointments with doctors faster and basically at the end of the day gets them out the door faster. Because as you know hospitals health systems in the U.S. especially are becoming cost centers not profit centers necessarily and the goal is to get a patient better faster and out the door not to linger in the hospital. So we're doing a bunch of these command centers around the country here in the U.S. at least Oregon Florida even Canada up north of the border there and then obviously Johns Hopkins that I mentioned. And we think it's one of those ways to look beyond silos look at a cross system approach and actually address the pain point that hospitals are saying is one of them and frustrations.

You know what. That's super cool band that you guys are focused on and this area of workflow. Because it certainly is as an issue in the healthcare system and just as we as we take a look at med device companies period definitely call out is how can you partner with your customer being the number one the health care providers. But to the consumer to deliver better care and Ben's example of these centers is such a great opportunity to add value to physicians and clinicians that are experiencing this burnout. Right. I mean we hear constantly. So kudos to you and your team man for the work that you guys are doing with this.

Yeah it's exciting stuff and it's something we're seeing actually sort of similar to technology adoption across leading institutions, we're seeing in places like Johns Hopkins doing this successfully getting some metrics, getting patient satisfaction scores of clinical satisfaction scores up and it's sort of spreading. Right. It's one of those things that spreads in a good way unlike a disease. But I think command centers or that idea of crossing your platform and really looking at those workflow questions at a macro level are going to be big in the next stage of healthcare absolutely.

Yeah that's so interesting. Now talk to me about a time when you have made a mistake or have had a setback. What did you learn from that?

Oh boy I think you saw I guess I'll go back early in my career and this is before I joined GE Healthcare I was right out of grad school fairly wet behind the ears and eager. I think like a lot of folks early out of school and early professionally to make a good impression, I would say back then one thing I lacked was that good sense around balancing my work life and my life life and my personal life. I think early on I felt pressured and maybe I pressured myself to work longer hours probably the necessary to basically defined myself by my profession. And I think that can create some good opportunities in the short run. But I think long term it was definitely a mistake on my part. I think of it like a we'll sort of and this is something I remember my dad sort of drilling into me as a youngster. He would say you know your life has has a lot of spokes in it right you've got your your professional life, your academic life, your social life, your family, your physical side of your life, your spiritual side and all those spokes are part of a wheel and if one is too long or you're focusing on one or two of those and not on the others your wheel gets out of balance and it basically what roll while. And I would say early on in my career my mistakes so was getting my wheel out of balance and probably overfocusing my life and work to say that it sounds like one of those interview questions you should never answer saying I work too hard. That's my failing right. But I would say this actually did do damage and it was a mistake and I think for a very patient wife in those times and sort of learning from good mentors I found that putting that much emphasis on work was probably not healthy in a lot of ways and having a good personal life and a solid and fulfilling life life actually helps sooner professional life. So that's sort of a lesson learned early on and probably a lesson that that all of us need to learn in the professional world.

And I am glad you bring that out because it's important in the healthcare space. We're working to help others with their health. When you don't have a solid health base it's a problem you know and a lot of thing that happened from not spending time in this space could be you know marital stress or financial stress or any other stressors that could lead to a deterioration of your health or lack of sleep. Super important that we focus on these and so I am glad that you brought it up. Is there any particular practice that now you do in order to help remind yourself to keep focusing on that life spoke as he as he said it?

You know I think you know several several folks I know try to turn maybe off their work phone or don't answer e-mails after a certain time at night. That can be a little tricky and in a global company. And when you have a global remit. So I definitely can't or don't do that. What I would say is I try to make substantial and sort of purpose driven commitments outside of work and that can be as simple as coaching one of my kid's soccer teams. Every every fall and making sure I'm I'm reading next to my teenage daughter and trying to at least keep an eye on the titles she's reading and make sure that I spend quality time with her. I think it's just being purposeful and your commitments and realizing there is a ton out there aside from work and actually engaging in those things helps you or helps your work focus quite a bit from me at least.

Love that been it for you man is a great great work that you're doing there professionally and personally. So now that you're sort of focused on this global business what would you say one of the most proud leadership experiences you've had to date with the business.

Yeah that's a good one I think a point to one that is health care one of our businesses makes maternal infant care products and those can be anything from infant warmers to incubators to basically life support systems for a prematurely born infant. And that's one of the most vulnerable I would say moments in the health care experience for any parent who's experienced that I have not had that experience and have known a lot of people who have and frankly what has been one of the most proud moments for me and for our entire team here is when somebody on staff has to go through that. And part of going through that you realize the products you're making the products you are talking about the products frankly that you are in solutions you're selling into the healthcare system are actually part of life and death decisions, are helping clinicians save lives and improve these incredibly small little infants who who don't have the greatest odds in your systems are actually increasing those odds. I think it's one of those moments you can sort of say I'm going to go into work tomorrow was there with a renewed energy, with a renewed purpose and say OK this matters. And you know a doctor a nurse any type of caregiver like that can probably have that driving force every day. I think when you separate yourself and join a vendor like free health care finding those moments where health care or the gimana monogram is on an infant incubator that has saved the life of a prematurely born infant. And it's the a child of a co-worker you go to work everyday with. That's a pretty proud moment it's not a it's not a revenue number it's not an operating profits statistic. It's not a growth rate. It's not anything like that but it's real it's personal it's tangible and it's really impactful.

Absolutely. Ben and it brings it home you know when somebody close to you if it's not you experience has the benefits of that.

Absolutely.

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

So the incredibly gargantuan project that sits on the horizon for me and for all frankly the health care right now flows from GEC you know John Flannery. His announcement about a month ago that they intend to make GE Healthcare standalone company. This was obviously big news in the press. Big news for investors and big news for the company. It's a serious challenge it's obviously a huge opportunity. And while our focus obviously stays our customers, clinicians caregivers and patients. That doesn't change, our name doesn't change, our DNA doesn't change. I would say other things will shift in this transition which is going to take anywhere between 12 and 18 months here and we're just on the front end of this. I think there's going to be an incredible amount of strategic and tactical work. And if you look at functions from a corporate perspective I think functions like H.R. Human Resources I.T. finance team and especially communications where I said we're going to be in the vanguard of that change is going to be a lot asked of us and frankly there's going to be a lot expected of us. And I. And that said we continue serving our customers continue business as usual helping clinicians best serve their patients and keep our promise to investors but also we need to make sure that we take the right steps take this journey toward becoming a standalone company in the right way. For me it's probably a once in a career type opportunity. It's really exciting and several levels but it's going to be a ton of work. And that's sort of the big projects sitting on the horizon for us.

For sure. Yeah. When I heard about that happening I thought you know what a great opportunity to really focus and really just double down on health care. There's nothing more powerful than their focus and I think that what's on the other side of it like you said it's just a tremendous opportunity you know.

Absolutely.

So as we work through healthcare one of the things that we like to do on the podcast is put together a short syllabus and you and I will do that here through our 101 course. We called for this one. The 101 of Ben Fox on the healthcare business of health care. I've got four questions lightning round now for you followed by your favorite book that you recommend to the listeners. You ready.

Absolutely. Let's go.

All right. What's the best way to improve healthcare outcomes innovate with the patient and the clinician in mind. So by that I just mean connecting the engineering design teams with the clinician and even the patient to have a time. Obviously med tech is getting more and more advanced with each iteration and in fact people are saying and you sort of see day to day that the innovation curve is going up at a steeper rate. I think what's important though is making sure that innovation is patient-friendly not just widget innovation for its own sake.

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

So I had a manager early in my career who used to give sort of three rules to live by and I edited them a bit but I would say they all touch on this question. His first rule was always use a number two pencil. In other words everyone makes mistakes. Be ready to erase something and move forward. Fail fast. So always. Number two pencil his second rule was no when a gallon of milk costs at the corner store. That was sort of a cynical way of saying do not get your head so stuck up in the clouds at the macro level that you lose touch with what's really going on on the ground. And that's very important for health care I think for companies like G.E. and even for clinicians to really know what that gallon of gas costs or gallon of milk costs at the corner store for the patient here in Wisconsin it's about 2 bucks 99 cents. I don't know what that is but that's the second rule and finally the third rule. He always called upod U P O D and that's just under promise and over deliver. And I think oftentimes you find yourself tempted to over promise and under deliver on things and really need to flip those. So just go with those three.

Love that van. Love the simplicity of it to use that pencil. Now what that gallon a milk.

That's right.

And UPOD baby. And love that that one is sticking my friend. How do you stay relevant as an organization despite constant change?

We are facing the question right now G health care I think one of the easy answers is we need to act as a startup act just like a startup would even though we're a century old company. We need to know its cliche make sure we try to disrupt ourselves every day so that someone else in the market doesn't do it for us. And it's a challenge but it's stuff like something we're aware of I'm working toward.

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

I would say keep the patient and keeps a clinician as your North Star so focus externally don't get stuck in your vendor provider pay your mindset and go from the mindset from the perspective of the patient and the clinician.

What book would you recommend as part of the syllabus to the listeners, Ben?

So two I read recently were Quiet. I think by Susan Cain and it's a it's a book all about the power of introverts. I tend to identify as one of those occasionally and nice and it was an interesting argument that there is power and introversion that maybe hasn't been recognized in the past. There's one I finished last week called artemis. It's a book about basically near future space travel on the moon and it's by Andy Weir. He was the author of The Martian which was the movie recently and I guess that brings me to the book I recommend if I had to. And it's not healthcare related but it's called Dune by Frank Herbert and basically you're not going find a better scifi sweeping narrative out there. I think back 15, 18 years ago when I first met my wife and we were dating long distance for a bit and writing a lot of letters back and forth and one of those times such a center of this book Dune and she was not a scifi fan but I knew she was the one she read it all and asked me. So I can give you a long list.

That's awesome brother. Appreciate that recommendation and listeners go to outcomesrocket.health/benfox, B E N F O X and find all the show notes, the transcript of our discussion today, links to the books that he recommended and all of the things that we discussed. So Ben. This has been a ton of fun. I'd love if you could just leave us with a closing thought and then the best place for the listeners get in touch with or follow you.

The best place to get in touch with me is just on LinkedIn. I think it's Benjamin Fox at GE Healthcare I don't think there's another one but closing thoughts. Thank you for having me on Saul, it's been a blast. But I would say I'm finding an introvert and a somebody who sort of recognize along with a lot of us that silos are an issue in healthcare as well as other industries. I think relationships are part of the answer and that's what's going to get us over some of these humps. And that's a personal, that's a professional. That's sort of a whole life whole wheel of life there, encouragement to myself and everybody there.

Outstanding advice there Ben. Thank you so much for spending time with us. This has been insightful and will definitely be keeping in touch as the months fly by here with this transition of GE. Maybe you would love to have you back on after the transitions over.

Wonderful. Would love to Saul. Thanks much.

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:

Quiet: The Power of Introverts in a World That Can't Stop Talking

Artemis

Dune

Best Way to Contact Ben:

LinkedIn: Ben Fox

Episode Sponsor:

Applying Crowdsourcing and Price Transparency in Physical Therapy with Efosa L. Guobadia, Chief Executive Officer at Move Together and John Randa, Physical Therapist at Northwestern Memorial Hospital

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

Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. Today I have a special treat for you all. We've got the co-founders at MovementX.. First of all, I want to go through a quick introduction and then we could walk through their personal experiences and anything that I left out. But I want to introduce at Efosa Guobadia. He is the co-founder at health tech company MovementX founder of the informational web site PT Haven co-founder and co-director of the international initiative PT Day of Service Co-Founder President CEO of move together to buy 1 seat 3 for purpose organization dedicated to improving access to quality rehab medicine around the corner and around the world. He developed and led the international volunteer program ATI mission works for ATI physical therapy which we all know a national chain and he contributed a chapter on sustainability as well as a closing afterword of the book, Why Global Health Matters. We also have John Randa. He's a physical therapist who grew up in the Midwest. Here he spent some time in Chicago in our backyard, the outcomes racket backyard currently works and received his B.A. in B.S. in kinesiology at the University of Illinois in Champagne Urbana followed by his doctorate in physical therapy from Northwestern University. Now he's a big part of the work MovementX. And I'm so excited to welcome these two dynamic individuals to the podcast. Welcome guys.

Thanks for having us Saul.

It's a pleasure. So John, Efosa, fill in the blanks there that I missed anything that you want to share with the listeners.

No, you hit it. Thanks so much. So thanks for that introductions. It's a hi pleasure to be sharing time with you. I'll also use this time to give a shout out to the rest of our team from MovementX. Two to my older co-founders Keaton Rick. These are Portland Oregon Justy Angel based on at Washington D.C. and we have other team members. Meghan Roussin of Portland Red Gilbert and Scott McAfee and then John. And what makes so much of the work we do fun is the people that we get a chance to do it with someone to give them a shoutout.

Awesome I love that special shout out to you all. So let's get to the root here. Why did you guys decide to get into the medical sector?

Great question. On my end, so I think early on when I was young, my mom is a nurse and she's been since. So I think the job when I was younger in my early words from a stethoscope or something like that. So I always had my eye on the health care sector and fast forward to college young undergrad the University of Massachusetts and we forget this at the time my sophomore year, my older sister was in physical therapy school at that time. Get her clinical doc in physical therapy and I hopped on the horn with her and I said just talk to me about the profession you know about physical therapy. And in that conversation we talked about the ladder ability of the profession within one month, week and day work with different patients of different ages with different conditions. And that really spoke to me. A rules we'll talk about the whole concept is in your hands and your heart and your words to work out who and to help others. And that really spoke to me as well and through all the time and even started from when I was younger my conscious mind and my subconscious mind I was falling in love with the whole concept that our police force throughout my whole life football all wrestling cross and play lacrosse at UMass as well Parsky lacrosse and then as I talk about continue to think about moving before I was even realizing I was loving moving really thinking about movement it start to hit me. That movement is one of the most important commodities in our lives. You know one of the oldest commodities in our lives with us from the very beginning and throughout. And it really dictates how we engage with the world and how the world engages with us, how we run, how we play, how we dance, how we love, how we live and is really drive my belief that when one is able to maximize their movement capacity and maximize the moving capability able to maximize the life. So I believe that's also humanistic. So much of my work today, occasionally is based around the transformative power of movements.

Love that Efosa. That's a strong message.

Yeah, it was a great answer. Tell.

John, what about you. What got you into this into this business?

So I grew up summered Faucette just being active and loving health and wellness growing up playing soccer since I was 4. I'm in love ain movement myself and I knew pretty early on whether as late Junior High or early high school that I didn't want to sit behind a desk for my career. Just love moving and so my parents challenge me to go ahead and look into what I wanted to do. When I just whipped up the U.S. News Report article for a top job satisfaction and physical therapist is right there. So I just combined my love for being active in helping others and to wanting to be a physical therapist and haven't looked back since I decided early high school that I wanted to do this.

Love that. What a great story guys. You know without a doubt, sounds like you've landed in the right place and so you've gotten knee deep into this space with your company, can you share with the listeners a hot topic that you think needs to be on every medical leaders agenda and how are you guys tackling that?

Yeah, a great question Saul. Thank you much for and I think what's been on my mind I think was big and many health care, leaders and organizations' mind, we really need to reframe how we look at our patients. No longer are patients these passive chess pieces to be moved along, along per here you know just sort of taken in the right direction away. Consumers now and patients now they're active, they're selective and they're more aware. And I think we need to see them as such, treat them as such and speak to them as such. We really provide a and power tools around them to choose what they need and when they need surgery or consultations. Other industries do this well and have been doing this well and use in other entities and extensions like technology to enhance the doing of this well. I think healthcare is catching up, healthcare does have complex tentacles to it. Not maybe all other industries have. But a, that's simply innovation will live for us right. Simplifying the sophistication and simplify our product and pricing in a way that patients. Now we started looking at more consumers that they could help pay to know what to do what. That's on our mind much. And I think that's going to be more and more health care organizations mines as well.

So how would you say and appreciate those thoughts. Definitely that the healthcare consumerism becoming more real larger co-pays mean that more discerning consumers what are you guys doing at MovementX to help provide differentiated care?

Yeah so it definitely one of the most of us getting into it a little bit at the end there is just the cost of healthcare in the U.S. and just how much of a problem that is. And that's definitely something that we're working on and how we're addressing this is we're just trying to provide the best care possible. What we're finding is if you go to like a typical private physical therapy place, you often will be double-booked with two or three patients at once and you're just not going to receive the individualized care that you deserve. And that will likely happen is you're going to draw out the visits that you need to get better. And that's going to keep driving up costs. What we're trying to do is we're going to provide as much one on one care with highly trained providers so that we can get the patients faster to reduce costs overall and improve outcomes as well.

So I now piggyback on that to piggyback on what John said and so so directly asked the last question and that is set up team and talk about MovementX and and what we are we know. So I always like to say. So the context and the concept and the content so that the concept of what we are really starts with any you know MovementX and movement is a fundamental value that I talked about earlier maximizing a movement that allows you to maximize your life. You know what we sometimes see in the world there is a bit of resistance to being healthier to be an active so along with so many other institutions organizations and just people talking about history, we want to make sure that we're encouraging people to be more active in moving. What our company does is not just encourage but enable people to be more active. You know that x40 start playing with the concept of it allows you to explore the world around you, allow you to experience the world around you. And we talk about ex being at the intersection of your best movement and your best life. You know so understanding our fundamental value and then as an organization it can't be the next thing that is building the architecture around that fundamental value. And that does what we're doing there is to bring in rehab clinicians and patients together on a centralized platform, that's one of the front of innovation for a MovementX decentralized platform allows for communication, documentation, payment and scheduling so we like to say create efficiency and effectiveness for people on both sides of the treatment table the patient or the provider so the patients are able to go to our site search for PT what they need, Number Beppo contractors empower choice as well. And what's also important for us is creating an environment for providers to have the support they need to very flexible, flexibly and per the passion and inspiration that got them into physical therapy in the first place and to build their clientele. And what this is ultimately about is quality effective experiences. We're taking the product a physical therapy a movement health or occupational therapy and rehab medicine to where the patient is and where that product could be more functional whether it's their home. Wether it was a fitness of where's the office. And to your question of how we're solving this. We just officially launched a couple of months ago Saul in about April. So we're pretty exciting times. So what we're seeing is, thank you so much, but what we're seeing is mission vision and being manifest that leaning into these pinpoint to the fulfilling of fundamental values being manifested when a patient has back pain or shoulder pain. So now they're able to go to our website within 24 hours 48 hours and they could be seen it that they had a PT come to their home. You know so we know all the research shows especially some of these musculoskeletal issues will be able to address it quicker rather than later. It is just a chance for that. It gives you a better chance here that the chance for that to become a chronic issue. So we're doing that to collaborate. That's what we're working on. And the final point is that the best that does that this best still has communication collaboration with other disciplines is specifically refer to other disciplines that interconnectivity is healthcare at its best.

Very cool, very cool. Thanks for walking us through that guys and. So in other words you guys are crowdsourcing PT and providing with that crowdsourcing some price transparency which is highly needed.

I love that word transparency because early on in this to be noted early on Rexy a cash pay eventually going to be integrating with insurance. Right now, we want to minimize the overhead in some of the operations that insurance entails. But we believe that's a front that we could go in often is because a lot of healthcare now as you do pay a copay but you get your sessions it is like that or your care and then a lot of your bill comes three or four or five or six months down the road. While a know without much understanding with this sort of control and personalization of selecting who treat you. You know as a provider that work with that provider to personalize your treatment plan and the scheduling of that and paying upfront session or be a bundling payment. You have more awareness of your cost and we think that's very important. And what we do to make that makes sense for the person will provide super bills to patients so that they could submit well received and super a bill to their insurance company or payer to get cover.

Yeah that's pretty cool. And another thing that comes to mind Efosa, John is you know I went to Walgreens the other day and I had like a little thing going on in my shoulder. I had like a tough workout my trainer kind of beat me up but it was good it was good and I'm like Man I need, I mean like when those little massagers so going to walgreens and I go to the section where the little massaging things and the yoga stuff is and I find it and there's a little like sticker on it that says you can use your flexible spending account or flexible savings account. Oh wow that's cool. So I carry it in my wallet and I go to the counter and I give it to her and boom wala! So just a thought for you guys if there's a way that you guys could somehow make your offering FSA approved this would be a big big motivator for people.

I love that thought.

Especially on the cash front right.

Yeah. Yeah I love that so much. We talked about that peripherally but in your anecdote in your experience. I want to bring that back center Saul. You know into your point what you just describe is also bringing and putting the product in that choice where people are you and Walgreens so well there's Walgreens or CBS or whether you're a yoga studio being able to get the treatment or the ability to schedule a treatment, whether it's virtually no platform or the places where you spend your time. And then again not everything needs to be a 60 minute treatments session. It could be a 20-30 minute work or just do a quick assessment. Look at the functional presentation of the structural presentation of sole shoulder also has serve a region maybe is thoracic region as well. So your findings and not get a treatment in 20-30 minutes and voila. And I could do a quick payment to your FSA. So that's a whole deal with without company building the infrastructure for that to be possible.

I love it. I love I love the idea guys and and I think this platform has the opportunity to be very disruptive to the current cost models and lack of efficiency as you've stated in the way that things are are organized today. All right so guys you're at the beginning of your of your journey but you're making some big strides. Give us an example of some setback that you had up to this point or maybe with a previous experience that led you to start this company. Take us to that setback. Let us know what you learned?

Absolutely. So at my first job as a physical therapist, I was literally like two hours a day for my 90 day reviewer they would just release me and I wouldn't be supervised. But I was seeing three patients at that one time and became focused on one of them. And then I saw another one was doing lunges with too much weight. And he ended up tweaking as quadriceps muscle so that that was not ideal but so certainly I could have been paying more attention and we would have been unable to prevent this situation. However looking back on it I just like zooming out and taking more of a macro approach. I started thinking about just what was going on with having to be responsible for managing three patients at once and that there is just an inherent problem with that. So when I heard about the mission of MovementX this year I just absolutely jumped at the chance of hopping onboard this wonderful company just to try to change that experience that I can give patients by being able to be put in a situation where I can just provide one on one specialized care for patients.

That's awesome man. So the opportunities there for you. The opportunities there for all patients and listeners, a take away that you should get after on some of the things that have been shared today is just that doesn't matter where you're at and where whether you be at the middle of your career the beginning or close to the end. There's always an opportunity for you to take it to the next level and make outcomes better and Efosa, and John are an example of just that. So I applaud you guys for your courage. Now what about the other side of the coin you guys have talked to us about a setback how about it. What are your proudest medical leadership moments that you've experienced today?

I'll jump in there. So some of my works also the nonprofit sector. So like you mentioned a afront and one of my moments is that I was able to be a part of early on and now I'm just hanging on being an inspiration by the professional large so cheers to work you so 2015, I did a trip around the world around 22 countries in eight months you know amazing and the idea is the hope was to create a montage mosaic of health service physical therapy rehab medicine different cultures around the world get a sense of the similarities differences and enjoy the beauties that lie within those and use that to be a better person and to do good in the world so great trip. That's be a long conversation for a long time.

We'll save that for when we meet and have some coffee together.

That sounds good, that sounds good. In month four, I was in Peru. I was doing some work in Iquitos, Peru which is only Amazon River you can only approach it by boat or by plane. And while I was in the Amazon while I was in Peru this one day in Iquitos I was taking a boat tour the service site. So I was on the Amazon River taking a boat to the service site and so a laso on his boat on my way to the service site this idea that had been in the back of my mind for some time simply shot to the front of it. The idea is this what will challenge students to conditions of the physical therapy profession around the country and around the world to do an active service on the same day and what will challenge those people willing do an active service share the moments happy images have connections made main line on social media in different websites. What might that look like a need for the bond within our profession. What might that look like in me for the bread of our profession to the world at large. So one of my co-founders on MovementX I called him and I emailed him as soon as I got back to the mainland that day about the idea and he was just so positive about it he said not only do we have to do this, can't not do this. So we started the other co-founder for MovementX Keaton Ray and we started this initiative called PT Day of Service and 2015 and the first year we had 28 countries participate in all 50 states in the U.S. the second year we had 42 countries participate in all 50 states in the U.S. and last year we had 55 countries participate in all 50 states in the U.S.. Now we have a team of 20 plus people that work on it now and just a friend within the profession that we know you know for any other professions just come together daily and serve locally in their community for a global affect. I'm proud to be part of the community now serving around the world.

That's awesome. And I love that you're like Yeah I was on the Amazon River I'm like you just had me at Amazon river man. Yes. Then it got better from there. You guys have done some really great things to create a movement around the profession of PT so something to be proud of. Congratulations on that.

And I'd even like to jump in on an experience that relates to that of faces with absolute machine and he started another non for profit organization called Nu together along with Josh D'Angelo that they built what was a couple clinics and a day last year right Efosa.

Yeah we will rebuild and rehab clinic in a second most populous city in Guatemala.

Not kidding. Love it.

So I was fortunate enough to receive an email from a Efosa last winter asking me to join him this year January turned me in a wave in Guatemala to serve for a week at the clinic they had built and that was without a doubt the proudest medical experience that I've had. We're literally providing physical therapy in its purest form and which the patient was getting the exact care that they needed without being rushed in and out of the door and there was just absolutely incredible to give this experience to patients when this was likely their first time just encountering another health care provider where we could listen to their problems. Just so empowering just just to see the difference we can make. And fortunately I was able to meet the other three founders and MovementX with Josh D'Angelo and Keaton Ray also being on that trip as well.

That's awesome. There's no doubt you guys are up to some really cool stuff I was looking at the PT Day of Service folks if you're curious go to ptdayofservice.com, you'll find them. You could find movement X at movement-x.com and no doubt you guys are doing some really fun stuff that is both meaningful and impactful and that's what we seek to do here. And the outcomes rocket has shared the stories of those who are doing what you all are up to. So why don't you tell us about. I mean no doubt MovementX is the exciting project but within MovementX, is there something that you want to share to the listeners about what you guys are doing there a project or focus?

For MovementX. Yeah. So like we launched three markets, where in Chicago, we're in DC and we're in Portland and I really know the infrastructure of the organizations that bring to providers and patients together where it's most functional. So one thing that we always say there's five fronts of innovation that we operate 5Ps you know one piece is a platform. The second P is that people know those are providers and everything. And really all people were really empowering our providers. Secondly is innovating payment. So when the people schedule our perceptions are looking at different a bumbling package and things of that nature. The 4th P is a product you know what's been fascinating for me to really think about since I graduated PT school in 2010. This is not just for PT this for healthcare is a really appreciate the whole spectrum of healthcare, or too often we focus on a hat. Wait for a person to be injured or sick or hurt you know especially with a professional physical therapy and really much of the medicine not just wait for somebody to be hurt to come to us or to see to see us. How can we work with people to help optimize you know their system and their body so soul comes in I see so again I look at his functional presentation structure presentation as a workplace environment, how he's doing what he does whether it's run, jump, play the whole night, based on what he tells me subjectively replacement I see objectively and basin with them talk about creating a precise and personalized plan for him. So we're creating programs we have a program called optimize it which would be the case and also creating us also small or mode programs or or Chronixx excuse me know which for work with different regions of the body and then it becomes about partnering with different companies organizations again where we can take that directly to their employees. So that's stuff that we're cooking in the oven right now Saul you know we're going to go vertical and the market Stodden mentioned before we go horizontal geographically.

Super exciting and listeners, I just had a chance to go over to movement-X and signed up, I created an account. It's pretty seamless. You go in and you could see all of the the PT providers that are available licensed and ready to service you. I think you guys should check this out movement-X. Check it out. It's affordable. And hey, if you want to do your part to make healthcare better try this out and consider it your way of doing what's best for health care but it's also going to help you. If these guys by the time you listen to this podcast I'm sure they'll get their FSA platform ready. So give it a shot right guys. You commit to getting this done?

I'm committed. We're going to look into it today.

I love it. I like it well. Whether or not it's done it may be done in there but you should check it out folks. I love the layout and I love where this is going guys. Thank you for sharing it getting close to the end of the podcast here. Let's pretend you and I are building a medical leadership course and what it takes to be successful in PT today is the 101 of these amazing folks at MovementX. So I've got four questions lightning round style and then we'll follow up by your all time favorite book. You ready guys?

Yup, fire away.

So maybe we'll do like what on one. You guys choose. So what's the best way to improve healthcare PT outcomes?

I think it's taking the time and listening to your patients. There's a quote by an infamous physical therapist Robin McKenzie and he says listen to your patient they will usually tell you the key to resolving the problem. If you'll only listen to them.

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

I think it's becoming complacent and straying from your mission vision and values.

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

I love that question. I think the key to that Saul is pulling parallels from the market or pulling from other markets or industry whether they were parallel or seen with less perpendicular orders Amazon or Uber or AirBnB or anything that you could think of. I always like to say Gretzky has his quote, "I wouldn't past the pop where the person was. I pass it to where the person was going to win". That's a mind and a mentality that grabs us.

Love that. It's one of my favorites. What's one of the areas that should drive everything and a health care organization?

I'm going to cheat on this a little bit but when I see what I'm about to say I see them all interconnected. I think one has to be product-centric and product believing the greatest options and products for your customers. When I see mission-driven you know a lot of things I learned from my time the nonprofits spaces for-profits need to be more like for-profit and in terms of being mission-driven and nonprofits need to be more like for profit when it comes to operation. So being mission-centric and mission-driven being customer-centric, lighting up your customer absolutely every single day, building this amazing experience around them. Amazon talked about that a lot. And then one is key I think all industries and all employess will do this better as being providers-centric. You know really feeding your routine nourishing providers and haltered conditions because when they're nurtured when they're supported when they're empowered that's going to lead to a better care and that's going to lead to better results. That's going to lead to a better everything. So as much as you think about our customer and our patients movement we think about providers as well.

I love that. And what would you say your all time favorite book is guys?

Mine is called the Winter fortress it's by Neil Basque and it's not a book about business or health or wellness actually it's actually a historical novel about a group of soldiers in Norway taking over a nuclear power plant that the Germans had taken over to prevent a nuclear strike. And it's just there's so many overarching undertones of just the grit and determination of the soldiers going weeks without eating and having to sleep in blizzards outside. And just like when I just think about just if I'm complaining about waking up at six thirty in the morning to go to a meeting or just try to keep building business growing I just have no reason to complain when I compare to what they do.

Great. That's a great example John and I'm a big fan of thinking about business and also the care process as seasons. Every one of us will go through different seasons and those that are able to endure the winter will come out on the other side stronger and ahead of the pack. I love that example.

I love. We're definitely going to have a dual copy Saul.

Let's do it.

On my front, Count of Monte Cristo is my favorite book, I'm not sure how nice.

That's nice.

That will be to the crowd, I love that book as Alexander Dumas and I just love so much about that book. What I'm currently reading now. It's a book called Peak by Anders Ericsson who talks a lot and Robert Poole is a writer on there. It talks about deliberate practice you know the right practice the right amount of time over x amount of time to achieve mastery of deliberate practice and Gladwell actually based a lot of a good amount of work on that with the outliers. Look at the whole 10,000 hours a minor injures versus research. Keep my ears open.

Love it. Great recommendation. The syllabus listeners is here for you. Just go to outcomesrocket.health/movementx and you'll be able to find that there along with the transcript, links to the resources, their websites and all the other things that we discussed and the books. You're going to find that their outcomesrocket.health/movementx. John, Efosa, before we conclude, I love if you could just share a closing thought for the listeners. And then the best way that they could get in touch with you.

Absolutely. Just in general I think just chase your dreams and embrace being uncomfortable. If you have aspirations of starting a business don't build it. Want to learn to play an instrument. Go play it. I just feel like it is so easy in this day and age to become content and not continue to grow and learn. I think we tend to underestimate the time we have in a day but overestimate the time we have in our lives. Just like paraphrase a quote from Les Brown he says the graveyard is the richest place on earth as there is so many unfulfilled dreams. Because someone is too afraid to take their first steps and carry out their dreams. So just go out move and do that brother and then yeah just in terms of contacting me just email, it's johncranda@movement-x.com

Awesome. Efosa?

Yes I love it.

Take us home baby.

A quote center founded by the Irish poet David White. Here's a quote. How do you know that you're on your own path, you can't see where it's going. That's how you know and how do you know they you're doing something radical, your path disappears. So the balance of always having vision but embracing the unknown and living your unique journey and humor. That's what my heart and that's on my soul.And there's three cogs I would say it is a wake abuse day. Know your daily joy and pursue it each and every day. The second a second cogs on my heart and his whole concept of living life with intentionality. You know like like John said solo or you want to build something build ability think the best person for job explained to the boss he or she is sure why you are. I'm 32 years old now. What I've seen in my 32 years is that opportunities don't come around to see them twice. At the very least they don't come around twice in the same form so when an opportunity comes around in the form misspeaks they're not grab by it's hair tops to say in our everyday play and move as much as you care. So those are my thoughts they're my email address is efosa@movement-x.com. It's been the highest of pleasure your time if you so and also share your time with your listeners. Thank you so much.

Hey it's been a pleasure having both of you. Efosa and John. Thank you all both for making the time to be with us and we're excited to keep up with your success because your success means the betterment of outcome. So appreciate you guys taking the time to be with us.

Thank you Saul.

Thank you Saul.

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 is one tiny problem. Health care is tough to navigate and the typical sale 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 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:

The Winter Fortress

The Count of Monte Cristo

Peak: Secrets from the New Science of Expertise

Best Way to Contact Efosa:

LinkedIn: Efosa L. Guobadia, DPT

efosa@movement-x.com

Best Way to Contact John:

LInkedIn:  John Randa DPT, OCS, CSCS

johncranda@movement-x.com

Mentioned Link:

MovementX

Move Together

PT Day of Service

Episode Sponsor:

Compassionate Quality Care For Seniors with Dr. Terrell Bacchus, Physician at ChenMed

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

Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. Today we have a wonderful guest. His name is Dr. Terrell Bacchus. He's the associate chief medical officer of dedicated senior medical centers in Jacksonville, a member of the ChenMed family of companies dedicated physician practices aimed to bring concierge style medicine and better health outcomes to the neediest populations. Low income seniors managing multiple complex chronic conditions. We all know this is an area that we're always seeking to do better with the limited funding and the high needs. And Dr. Bacchus is a physician leader in this space for the new Jacksonville market where three dedicated centers will open this summer. Previously Dr. Bacchus was the medical director in Atlanta for five JenCare senior medical centers also part of the ChenMed family in Atlanta. The quality care of Dr. Bacchus and his team led to Jane care rates of emergency room visits that are 50 2 percent lower than the regional average. If that didn't put a hook in on the amazing things that this man and his team are doing I don't know what will happen but I'm sure it did. And so Dr. Bacchus just want to say welcome to the podcast.

Well thank you for having me so I appreciate it.

Absolutely. Now did I miss anything in that intro that you want to fill in that you want the audience to know about you?

No I think that covers it all.

Awesome. So what is it that got you into this health care business?

Everybody asking why did you get into medicine and I think it started with my father. He was a very bright man he always knows everything that's going on very mechanically inclined and he spark this inquisitive that this in me to really understand everything around me and so on. It's one of those kids that broke everything I had apart and tried to figure out how it worked. And one thing I couldn't break apart to understand was the human body. And you know that led me on a on a journey as I went through school and got to medical school and started learning more and more about medicine. And as I got there and got the residency I realized there is such a big need for medical care to the underserved. And you see people that are that are just being left in the shadows and that's what led me kind of to ChenMed, to learn their vision to be America's leading primary care provider Transforming Care of the neediest populations really resonated with me. So I investigated further and you know I have been happy to join this organization that's taking on such a honorable mission.

What a great story Terell, and you know it's so wonderful that you've found this field where the challenges will always be there and you've honed into a very specific market. I think that it's definitely going to be rewarding what you could do for the market as well as what you'll get out of it as far as fulfillment. What do you think is a hot topic that needs to be on every medical leaders agenda today Terrell and what are you guys doing about it?

You know I think everybody should be focusing on value-based patient centered care. The most important thing that we can do right now. We understand that we need a change. And I think that's the change that everybody's looking towards. You know specifically ChenMed as an organization. Our mission is that we honor seniors with affordable VIP care that delivers better health. And if I can break that down a little bit we honor seniors and we're very patient oriented and that way we want to take the best care of the needy seniors. And then also the affordable part. We want it to be affordable to them. And this is what we do in our centers. We have door to door transportation. We have onsite med dispensaries. We have Silver Sneakers classes for the folks to come and exercise and we have our specialist all on site so that our patients are driving all over the city, paying for transportation, paying for parking and then paying copays to see these folks. They get very expensive and you know as you know our populations that we deal with are low to middle income seniors and the majority of my patients are at or below the poverty line. So you know we have to keep that affordability not just to them but also we're trying to create and affordability to the system. And we know that you know we're spending exuberant amount of money and really only coming in middle to last place of healthcare outcomes in this country. So one of the important things that we do and also that VIP care section really delivering that concierge type medicine that really is affordable to the rich. We want to get back to the people that need it the most. And another part of that is VIP care versus health care. I think we separate that out because we realize it's not just big health care that we're taking care of. We're looking at the person as a whole and we realize that 80 percent of that equation is not just intended to remove medications and health issues it's you know the socioeconomic issues that surround them. And so for that respect we have the case managers, have transitional care team, behavioral medicine therapists and a number of different ancillary staff that help us to really get the whole picture of the patient and that helps us deliver that care. And then in turn when you deal with that 80 percent and you're able to deal with them that delivers better health. And that's kind of our mission here. So I think keeping that value in mind and then also keeping the reason we're here is for our patients, keeping all that in mind is really what should be important to everybody right now.

That is fascinating. And the way that you guys are tackling that is very purpose-driven Dr. Bacchus I find it very very inspiring folks if you go to ChenMed.com you'll see some of the the mission and things that Dr. Bacchus was guiding us through. ChenMed.com. You'll see all the things that they're up to their facilities really span from Florida up to the east coast and some of the Midwest and Louisiana but they're really broadening their footprint because this is a huge need. And thankfully somebody like ChenMed and Terrell are really focused on addressing it. How do you guys partner with providers and payers Dr. Bacchus?

We partner with specialists that are in the areas trying to find the best providers that are in the areas that we're going to you know we're opening. We have over 40 plus clinics in six different states. And I think this year we're opening over 10 new clinics right now. The growth is just exponential and I think we're finding that there's a lot of places that need our help and so when we go into a new market, we look for a specialist and payers that are willing to work with our model and that want to provide the kind of care that we really strive to provide here. And sometimes we find some people that don't want to. But majority the time we find like-minded people and really build and cultivate relationships with them.

That's fascinating. So mainly focused on seniors. The Medicare Advantage you guys covering also Medicaid?

Yes. So it's all Medicare Advantage but also the mix of Medicare and Medicaid as well.

Got it. Medicare Medicaid as well. Very interesting. Very interesting and you guys are very focused and you're expanding the need is there. Can you tell the listeners Terrell an example of how your organization ChenMed has created results and improved outcomes by doing things differently?

At ChenMedand in our group we do a lot of things differently than you know the regular fee for service world. But one example that comes to mind quickly was we think face time with their doctor is one of the most important things you can have. And on average we have 10 times more time with our patients than a regular physician in the community.

Wow.

It's amazing. It true it hasn't made them more time to take the more time that you get to spend with the patient. The more you learn about little things and if somebody is able to come with us instead of per day and learn the little things that we see on the patients you know whether it be an unsteady gait walking into the office or medicine bottles that shouldn't be full that are full right now. You learn these little things the more that you see that patient. Every little touch point is so important. And then we create accessibility to your doctor. Not only do you get that more face time but you have you have the ability to call the center anytime you need us. But also every patient of all of our doctors gets doctors phone number when they have a cell phone and you can call them and get that immediate access that you need so that our seniors aren't ending up in the emergency room or ending up and sitting at home in pain or having distress. And I think that really changes things for us. And like you mentioned earlier, this has happened has led us to here in Atlanta lowering our E.R. visits by more than 52 percent. And so we really celebrate our walk-ins. We have walk-ins all day long and there is no specific little period of time that you can only come in. We celebrate them when they come in. We're happy that our patients trust us enough to come and see us first. And we can help direct their care.

That's amazing. Folks I just got goosebumps when Terrel said they celebrate their walk-ins. Think about that. I mean that is tremendously insightful. And when you think about the future of health care, you guys are definitely where the puck is going. I agree. So can you share a time when you guys had a setback. Terrel, I know it maybe hasn't always been this smooth you guys felt like you hit the mark but maybe you missed it. Can you share a time when you had a setback and then what you learned from that setback to make you guys who you are where you are right now?

I think a good thing that highlights a good example that highlights our model here is a mistake that I made when I first came out of residency and I joined ChenMed. You know I had a patient like had come in and blood pressure is a little bit on the lower side. Sweet little lady and I said you know let's switch are under medicines and stop one and change this and change the course on that. And I did some changing probably more changes I should have done in that little visit. And whatever diuretics her water pills. And then I said hey you know we'll see you back in two months. You know and I thought that was sufficient. And next thing I know it about two weeks later you know we get alerts and we have we have meetings where all our providers come together and we review or inpatient or hospital patients that are there. And her name popped up on the list. And I was astounded by you know what happened and I realized that you know she had stopped that water pill and eventually you know food has started building up and she went to food overload and had to be seen in the hospital had a very short stay that I have Easterns go back out. What I learned from that was you need to see patients frequently especially when you're making changes in the elderly population. There's no more of this. Oh we'll see you in six months we'll see your doctor twice a year. It's really. We can see our patients here at ChenMed every day fighting to our patients that I see two or three times a week just to keep them stable. And this was an example of where I could have made that medication change on a Monday. And seen her back on Friday or seen her back at all on Monday to monitor that. And if I saw her, I would have been able to. How about you. Your legs are a little bit more swollen here. You know that's, I mean reassess what's going on. And I think it really helped the model get into my head and understand why we should be seeing her patients more frequently and really being more cognizant of the changes that we're making in our elderly population.

That's fascinating. And so you mentioned there an inpatient component. So you guys do have some inpatient services?

Correct. So if our patients end up in the hospital usually have a hospital team that can take care of them some of them are employed by some of our hospital groups but they'll manage the patient alongside of us so our patients going to the hospital we're not just oh you guys take care of it. You know let us know what happens after. It's very much that the doctors are involved. Our PCPs will call the hospital list and disgusting. It's important for the person that knows that patient the best to give some information and some context to what's going on. You know patients may show up in the hospital with some sort of a decrease in their kidney function. So for somebody that doesn't know them they'll say oh this is a huge change and so quickly whereas the person has seen them for the past five years can said Hey no it's just been like this for about two years it's not much change. No need to go and do a million dollar workup on it right now. Let's watch it and see what we can do together to help get this patient back out with things more healthy days outside of the hospital. I think those little pieces of information from the PCP are so important and so that's why we on Wednesdays we usually need as a group or doctors in or in our markets and goal for these inpatients to really understand why they ended up in the hospital. How did they get there and what can we do to get them to the next level of care get them back home to a family. And we also you know it's a component of accountability for doctors is examine why where did we go wrong. Is there something that we could have done better for this patient. Like I said in my last story. It's where I learned I should have seen that patient sooner. It helps us to really take better care of seniors. You know we really treat each of these Hollywood missions as a failure and we have to examine that breakdown and be accountable to our peers on what we did and what we're going to do better next time.

So fascinating I love it. And that's thanks for the clarification there. Dr. Bacchus I was thinking that you guys were also a you know had a hospital component but you were saying to just you flow with the patient the patient is the person is not a baton. You don't just hand them off to the hospital and forget about them.

Exactly.

I love it. So what would you say today is your proudest medical leadership experience that you've had to date?

I was thinking about this and I think it's my most recent one is actually just happened. We certainly Naggar inaugurate. Yes and we just inaugurated two new position partners here in the Atlanta market. And to become a physician partner. Thank you, to become a physician partner is is quite the feat. It takes a period of time a specific time to get to this level and then you have to reliably produce results, are outcome based results that show that you're taking very good care of your patient. ChenMed takes this very seriously because we want our doctors to be the best in the community and provide outstanding care for patients. So they've developed a training program that's a yearlong program that helps develop these other skills you know outside of just the medicine books but you know how to run and and you know manage a team because you have a team at that position here in JenCare You have a team that consists of your nurse referrals coordinator and a frontdesk statff that really help you manage this patient panel that you have and you know things like the business side of medicine. Looking at how to do the IP service, things that you don't learn in medical school. So it really helps get our patients. I mean our doctors to that level and to see some of my doctors here in this Atlanta Market. Get to that stage is truly amazing and makes you feel really good that our patients are getting that kind of care.

That's beautiful. That's beautiful. Well congratulations to those two new members. It's not easy you guys made it. You guys and gals made it. Congratulations. So folks this is this is fascinating. And when you take a look at a company like ChenMed it makes you wonder why you know why are they doing things right. Whereas it's hard sometimes for us to change how we are doing things. It can be frustrating. If you go to ChenMed.com, you'll see the story of Dr. Jenling James Chen. He's the founder of ChenMed. He was diagnosed with cancer ten years ago. Given two months to live and during his care, he experienced firsthand the frustrations associated with navigating these choppy waters. Today, that's why this is their mission and they've aligned with amazing people like Dr. Terrel Bacchus to help them drive forward this mission and accountability. Compassion is at the center of it.

Indeed>

So tell us about an exciting project Terrel that you're focused on today.

So my and my most exciting project that I have going right now is Transforming Care and Jacksonville. We're going out to the Jacksonville market and we're going to bring the same level VIP care that we deliver in all of our markets to the Jacksonville folks that really, really need it. There is a need and we've seen it, we've identified it and now we're going to help take care of it. And I think putting all the pieces together, we're going to do the beautiful market out there and really help the seniors who truly need our help and like we have mentioned before you know we're getting into the market and we're meeting with the hospital CEOs and we're meeting with the specialists in the area and really getting our model out there and trying to find like-minded individuals right now.

Outstanding. So if you're in Jacksonville listening to this or anywhere in the surrounding area, in the end of the podcast we'll be able to provide a way to get in touch with Dr. Bacchus. So you too can join the movement. Let's pretend Dr. Bacchus you and I are building a medical leadership course and what it takes to be successful in medicine. It's the 101 of Dr. Terrel Bacchus. We're going to write out a syllabus and we've got four questions followed by the book for the syllabus your all time favorite book. You ready for it?

Sounds good, let's do it.

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

The best way to improve healthcare outcomes is to get patients in front of doctors more often. I believe that's the key to everything that we do here. More face time the better health outcomes we're going to have.

What's the biggest mistake or pitfall to avoid?

Overlooking the importance of the relationship between the doctor and the patient. I think it piggybacks on that first question. But the stronger the relationship, the more that the patient tests the doctor and that they're able to accept the care that they're trying to get.

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

I think you know at ChenMed, were focused on being America's leading primary care provider. And I think we understand that change is needed and we embrace that. We know that the medical system is not work should be. And we know that there's much improvement to be made. And I think focusing on that and being nimble and dynamic enough to continue to move down the road towards a better health system.

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

The focus again comes back down to the patient. I think building the patient relationships and also developing physician leaders the company does this very well and helping to develop doctors to help run the organization. I think it's commendable and something that's not done very much in the outside of ChenMed.

Are you guys hiring physicians?

We are hiring physicians who are looking for great doctors that are like-minded and want to be on this journey with us to really help transform care of the neediest populations specifically in Jacksonville and over all our new markets that we're opening but we would love to have anybody that wants to join our mission and is ready to you know transform this care with us.

There's a little plug and if you're a physician listening to this by all means and you're tired of the status quo. I think this is a wonderful wonderful practice for you to consider. ChenMed.com, you're going to be able to find all the show notes as well as outcomesrocket.health/chenmed that's C H E N M E D. What book would you recommend to the listeners Terrel?

You know my favorite book that really relates to what we do here as Being Mortal by Atul Gawande. I think it really opens your eyes to this end of life issue that we deal with on a daily basis with our seniors and what it truly means to them and how we can take it as people that aren't at that stage and really be empathetic and really understanding of what's of what they're going through. It really changed a lot of how I practiced and how I'd present myself to the patient.

What a great recommendation. Mr. Gwanda has come up several times, this one definitely is a great one. Folks if you haven't read it, take Dr. Bacchus note on this one, read it again. Everything that we've discussed the show notes, the transcript, resources, everything's available at outcomesrocket.health/chenmed. Before we conclude Dr. Bacchus I'd love if you could just share a closing thought. And then the best place where the listeners can get in touch with you to collaborate.

I think the most important thing we talk about you know in all times is what we're doing here in ChenMed and how we're so different and I think it's hard for people to really understand what it is. So I am sure everybody to come and visit and I guarantee you'll be glad that you did. You spend some time in the waiting room talk to patients. Meet our staff, meet our doctors. I think you'll be pleasantly surprised. And we'd love for everybody to come and join the ChenMed family.

Outstanding. And what would you say the best place for listeners that want to collaborate to connect with you is at the Web site. You have a different account that you want them to get a hold of you with?

Yeah you can definitely get a hold of us through the website. And also you get through to me personally at terrell.bacchus@jencaremed.com.

Outstanding. Thank you for that. We'll include that in the show notes folks. This has been a pleasure. Dr. Bacchus, again I'm inspired by the work that you all are up to and we're looking forward to staying in touch.

I truly appreciate the opportunity. So thank you for letting me. Get the word out to the masses. I appreciate it.

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

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Recommended Book:

Being Mortal Illness, Medicine and What Matters in the End

Best Way to Contact Terrell:

LinkedIn:  Terrell Bacchus, M.D

E-mail:  terrell.bacchus@jencaremed.com

Mentioned Link:

JenCare

ChenMed

Episode Sponsor:

Mastering Bundled Payments with David Terry, Founder & CEO at Archway Health

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

Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. Today, I have an outstanding guest for you. His name is David Terry. He's the founder and CEO at Archway health as a CEO of archway health. He's a thought leader and frequent speaker on bundled payments and other payment reform initiatives with over 20 years experience in healthcare. A trusted strategic adviser for providers and all along the continuum. He has successfully led care and risk management initiatives with primary care physicians, specialists acute care hospitals, pediatric health systems, skilled nursing facilities, home care companies and hospice providers as you can see. His experience spans the entire continuum of health. He holds his MBA from Harvard Business School and he's got the experience to back up a fantastic discussion today. So what I want to do is welcome our wonderful guest David to the podcast. Welcome.

Thanks Saul. Thanks so much for reaching out to us. We're really excited to be here today.

It's a pleasure to host you today David. And so I'm curious what is it that got you interested in health care to begin with?

Yes that's a great question I think you know I read a little about your background I mean like you have had family members who've experienced the health care system and this as everyone has and can be a frustrating experience so drawn to trying to figure out how to improve that. And then also I guess a couple other things. One it's such a big part of our economy and growing our economy and doesn't work as well as it could. So it's a big set of problems. I get our arms around and see if we can you know make a difference on something that's important to all of us and then as individuals as well as very important to our country. And I guess also this from a professional perspective, it such a dynamic industry with so many different aspects to it you know around obviously critical care and science and ethical issues and economic issues and political and sociological issues and it's just a dynamic environment to work in with a big important problem that kind of drew me into it in the very beginning and started work in health right at a college in 1990 and I've been in the industry.

That's awesome. And you definitely have a passion for making things in this system better David, in particular the the payment models which listeners archway is focused on on these payment models how can we make them better. And we'll be diving into a little bit more about the focus that they have there at Archway. But before we do David, I'd love if you could just share a hot topic that you feel needs to be on every medical leaders agenda and how you guys are archway are addressing it?

Yeah. So for us the biggest topic is sort of the the core of what we're talking about on the theme of this discussion of payment reform. You know our mission atarchway is to fix healthcare to kind of reform in the underlying is the basic thesis that fee for service doesn't work. It doesn't serve us as patients as lead to you know ballooning health care costs without really understanding what we get for those costs from a value perspective or from an outcomes perspective. And so I've been thinking about this and working this here for a long time and over the years we've sort of peaks and valleys of interest in moving away from people service whether it was towards capitation or pay for performance or carve outs or those types of things. But this is the best time in my 25 years in healthcare to be thinking about different payment models and value based care. It's still early frankly even though we knew this for a while you know Medicare is certainly driving the process or seeing more interest from actual providers. So it's really a transition away from fee for service toward more value based models. Is what we think about over time.

For sure. And so like five years ago when the topic of fee for service really started gaining some traction I found myself in a room of healthcare executives and there was a panel up front name. They asked the question hey how many people in here are focused on value based care versus fee for service and very few hands came up and fast forward meaning that I was at couple of months ago half the room had their hands up. So to your point progress is being made and I'm just curious what you believe the timeframe before we actually start seeing some of these programs take into effect and be the majority of how we do things.

You know it's really a question I would have said five years ago that we would be there now and we're not. So you know hopefully within the next five years we see the majority of payment being made in some sort of value base, outcome base structure rather than fee for service. What was encouraging is that Medicare and CMI continue to drive this forward. And you know I think I took a bit of a hiatus transition from the Obama to the Trump administration. But through a few announcements including the announcement of the BPCI advance program bundle payment prepare approve an advanced program and go what's happening in NexGen and what we're hearing from the new secretary of Health and Human Services in Burma. It seems like there's a lot of momentum continuing to come from CMI which is obviously very important. We're seeing more coming from states as well and state Medicaid programs the commercial market frankly is still behind in what's happening in commercial health plans. And we're seeing some activity from commercial plans. I would say we're seeing more activity and noise and anx from self-insured employers both large and small who are increasingly dissatisfied with the value they're getting for the dollars they're laying out for healthcare. So there's certainly momentum. I think it is a very good time to be working in this area. But again it's still early. So I would say hopefully in the next three to five years, we reach a tipping point and it's encouraging to hear that the meetings you are in, there's a lot of interest and enthusiasm, counsel providers to do is if you have any way to participate in a value based Medicare program they are definitely worth pursuing and at least evaluating because those programs are while they they're not perfect they share a tremendous amount of data much more freely than what we see in the commercial market. And the rules are clearly defined where it can be complicated but the rules are written down. And so you can look at the data look at the rules and see a clear path to what it will take to be successful.

Very interesting. Lay on the lamb there David and you know curious to learn a little bit more about Archway. Tell me about the approach you guys use there what makes you guys different than somebody else that would be helping providers or organizations make a transition into a bundled payment or other type of risk based platform?

Yeah. So I think a couple of things. I mean first of all we are we're bundled payment company but what we've really learned and evolve to become based on our experience and bundle payment is, we're focused on specialty care management and helping specialist and specialty providers take and manage risk in a very focused way. And you know having worked in accountable care organizations are very close to a primary care physician and have been part of large hospital systems specialists have sort of gotten lost in the shuffle a little bit in this movement but the way we look at the data is about 70 percent of healthcare spending is controlled and initiated by specialists and that makes sense because we use the most resources and then people need the most care when they get sick and that's when they need to be with specialty providers and really one thing we learned is the biggest variable is whether you're going to have a good experience and a positive outcome is who is the specialist you're working with and how good are they at what it is you need them to do. And there's a lot of variability around. So we're very focused on specialist specialty care and the reimbursement model that matches that at the bottom. So we kind of match the look to match what the data says and the expertise of specialists with the payment model that rewards them for being really good at what they do and develop and delivering care and official, right.

Fascinating. Now listeners if if something that David said resonated with you he's going to share best. Best place to get in touch with them here at the end. But definitely I think it's a good time to take your programs to the next level, decide and comment on a direction that you're going to take. And part of the beauty of being here with you with David on the outcomes rocket is that we get to share these isolated pockets of of information and expertise. And just so happens that David is is a bundle payment guru that could help really understand and lead the way light the way in your bundle payment processes even if it's a basic gut check or pressure test if you did it right. Or maybe you're on to the next one. So something to consider as we unfold the rest of the interview here with David. David, it hasn't always been rainbows and sunshine. He take us to a time when you had a setback and what you learned from that?

Yeah I mean I would say I was very excited about the movement toward global capitation back in the mid to late 90s through them. You know mid 2000s this was when Medicare Plus Choice was developed by ICMS. And you know the first version of Medicare Advantage really and we started to see commercial plans in certain markets like Massachusetts and California and Minnesota move toward global capitated contracting. And you know I worked at Partners HealthCare Boston at the time and we had about 4000 lives and we will cap contracts in Medicare Plus Choice for a couple of commercial plans. And I worked very closely with our primary care physicians to manage patients in that program and all the stuff people are working on today around hospital innovations, E.R. visits radiology tests generic prescribing all those types of things and you're working with primarily with the primary care physicians to manage that. But the other day we really struggle to make an impact. And I think there were a number of but ultimately failed frankly to see with those programs and partners and a lot of other providers and payers cross country moved away from risk based contracting in the early 2000s Medicare Plus Choice shut down and it took a while for us to get back to where we are today. But yes learnings for that were you know I think primary care is obviously a key part of the delivery system. It's very hard for primary care physicians to have enough input and leverage really when patients get sick. So we struggled with managing that process. Everyone else while the primary care physicians were kept and there was accountability there. Everyone else could pay a fee for service so the specialist would be the service the hospitals run the orgies. Nursing homes ar e for DM. And the model just wasn't enough alignment in the model. So you know fast forward to where we are today and I think we're getting better at the alignment. So I think there's a long way to go. Most ECOs are familiar with have not adopted reimbursement models or even compensation models for the downstream providers that are value based. But with things like the ECOs in bundled payments and especially carve out and some of the things are happening to better manage post cue care I think we're getting better at it. But it's been a long road Saul, I've been doing this twenty five years really trying to figure out what the magic bullet is and it's it's really hard but I think we're getting closer. I think what's getting us closer is much better access to data, so much better information and the ability to fold that into these different types of reimbursement models are getting more traction.

Yeah that's very very fascinating David and you're dedicated man I admire your tenacity and your long term approach because you could have a life man. You could have done something different but you're still in the game. What keep you in it?

That's a really good question. There have been moments of doubt, get me wrong.

I'm sure.

Yeah you're right. So I appreciate you sensing the passion. I think this is a this is a bit of a quest for us. We've got a great team here at archway, there about 30 people now. Many of us have been in healthcare for a long time and have been committed to your of finding a better model, a better mousetrap. But I'll say I guess at the beginning it's a big problem right, and one of the things I guess for a moment. But you know when I started healthcare in 1990, we were spending about 12 and a half percent of our economy of our GDP on health care and it was pretty universally regarded as a mess. And you know that was in the run up to the Clinton election and Clinton's which was suppose to fix it. That didn't happen. And we thought maybe 12 and half or 30 percent was as high as Bigo as the economy and after working in this field for 25 years we're now spending close to 19 percent of GDP on health care. It's still highly regarded as a mess. And that's not a good personal story to reflect on from a career perspective because we just haven't made a dent in improving it. And that's not the epitaph I want at the end of my career and so, there's no better time than now to sort of with with what's happening from Medicare and what what we're starting to see some folks like Amazon and Wal-Mart and even smaller employers really try to want to find the way to solve the problem. So it's a great time to be doing it, certainly not easy but there's nothing I'd rather do. It's hard but it's fun it is a good way to spend my time.

That's awesome and I love that I appreciate your passion for listeners. If I'm in this game, I would want David in my corner curled up and tackle these issues. I'll tell you that because if he's been in it for 25 years the little things that may come up here and there that are a nuisance. I'm sure he's run into on time and again. So definitely check them out. They're doing some fascinating things. Go to archwayhealth.com. You'll see the things that they're up to. And a little bit more about what we've discussed here today. So let's see the other side of that David. I mean it's been a grind but you've also experienced some highlights. Can you share with the listeners maybe one of the most amazing experiences you've had in this space today. One of your proudest moments?

Yes I think there are a couple. I mean one is just thinking about what we've been working on the last 4 1/2 year and a stone archway. We've been in all of the Medicare bundle payment programs using the BPCI and the ecology care model, conference which are replacement model. We're now in the BPCI advance program and BPCI, we've seen reductions in cost per episode on average of nine point eight percent per episode with some providers experience savings of almost 20 percent per episode. And that's where we'll also see improvement in outcomes in terms of reduced readmission rates, reduced complications, people getting home back home faster. So you know that's just I've never seen improvements in the 10 to 20 percent range. And then the other reimbursement program. And so that's very funny. The second piece of it I guess is how we got there and this is just because we're not and we knew this going in. But this is what we've learned. When we get there is we get to partner with really good specialists and because we have so much data, we get to see what outcomes and value looks like when patients are with really good specialists who are focused on their core specialty area and passionate about that area and have high volume and good results. And then we go and meet those folks and we talk to the orthopedics surgeons and we talk to the oncologist and the cardiologists who look really good in the data and we learn about what it is that makes them different and there are things that you know we've sort of commodoties vision. Not everyone I mean everyone may not agree with us but our view is sort of commodoties physicians in general and particularly specialists. So it's really hard to know whether you found a good specialist when you get referred to one. And the unfortunate reality is there are not all the same what we can see in the data we can find the ones are really good and we can really learn about what makes a difference and then we can take those what we learn and we can apply it you know across all the programs we're working in.

Fascinating. Now listeners what I find is the best in the industry are very knowledgeable and I would say that that's very true for David and his team and archway. The thing that sets apart the outstanding organizations from the good ones are average is that they're willing to share that knowledge and David's doing just that here. Also if you go to their website archwayhealth.com, if you hover over the BPCI advanced link, there's a link to webinars and they are putting out webinars to educate those that are looking to take their bundle payments knowledge to the next level. Check them out and I'll put a link to that particular webinar tab in the show notes so that you don't miss out. That is a true marker of a company that's fully invested. They want the best for the industry. And David and his team are doing just that. David what would you say an exciting project or focus that you're working on today?

Yeah so the biggest thing we're working on right now is the BPCI advanced program. So you know originally the program was announced way back in the beginning of 2016 and the Obama administration and there was a little bit of a hiatus as I mentioned earlier but in January of this year CMI launched the bundle payment for care improvement advanced program and that's a follow on to the original BPCI program and there was open enrollment period from January to the middle of March. We signed up over 350 providers across the country to evaluate that program and then decide whether they want to move forward. So we're just actually having to just literally now starting on Friday and going into the middle this week getting pricing data and baseline claims data for all 350 providers. And we'll be sharing that with folks over the next 60 days to help them decide whether they want to move forward they have to make that decision at the end of July. So we're on the road today down here in New Jersey meeting with some providers were in Philadelphia earlier today. So we're right now, analyzing that information helping providers decide whether they should participate in the program, what their opportunities look like where they can drive improvement in outcomes and reduce cost. And if it's attractive for them to tack to debate. And so you know 80 percent of what we're spending our time right now is on that addition or active was very active in the oncology care model which is a similar program but for oncology patients that's on a different timeline. But that's been the fund that's very successful. The last thing we're doing is the very thing we're doing is starting to work with some self-insured employers to apply what we've learned in bundles and Medicare and take some of that. So same strategies, sell self-insured employers approved through specialty care for their employees.

David, that's a really great call out. We've been sort of talking to these points. In my mind, I was thinking providers but at the same time there's that large percentage of employers if you're an employer listening to this maybe it's not you maybe maybe you're not the one to get educated on this piece but maybe it's somebody within your organization. Don't miss out the opportunity in leveraging a company like archway to help you get the most value for your healthcare dollar. Because you deserve to get the health care that you pay for, nothing less. And so our great call out there by David on the things that they're offering, oncology BPCI it's just terrific effort, David and I want to commend you and your team for the wonderful work being done there.

Well I really appreciate Saul, it's a and I appreciate and I think you're saying about it. Certainly you know knowledgeable about what we do and committed to the cause here and thanks again for reaching out to us.

Absolutely David. Now before we conclude I love to ask you just for your favorite book for the listeners. And then one closing thought.

Yes I saw them on your list. I recently finished Moby Dick. I tried to read that about 20 years ago and I failed and I picked it up again. And it's one of the favorites I read recently. It's not easy book to get through it took me some time.

What was your biggest take out from that?.

You know I think one is it's just an amazing study of sort of the undershot you know what we understood back in that time about the science of whales and the ecology of the ocean and those separate things that very very detailed around that. So that was very interesting and then I think the other piece is this is the esoteric I guess but it's really a study of good and evil and what prevails. And it's a book about faith, faith versus will versus freewill versus versus preordained things. It was just you know obviously it's a great book and I really enjoyed reading it even though it did take me a minute to get through it.

It's really interesting David. I've not read it before but you know interestingly I took my son. He's 15 months old to come to the to the aquarium and we were sitting there and they showed us a picture of a dolphin's fin and if you ever see that and this is true for any sea mammals dolphin or the whale or even like just any sea see mammal. If you look at their fin, they actually have the structure of a human arm and the metacarpal is in phalanges.

Right, right.

It's believable, did you know that?

I did know that, I've been to the whaling museum in New Bedford before it was not far from Boston and they have a skeleton of a whale there and I have seen that I think the folks who study this believe that they don't there's no purpose for that it's just an evolutionary happenstance.

It's fascinating, Isn't it?

I don't know if you've heard that. Yes.

Yeah. You mentioned and I just think folks if you have a chance I mean if you're driving if you're driving for later but I think you'll find this interesting, Google a whale skeleton or on a dolphin skeleton and you're going to see that that the skeletal structures like ours but the radius and the Almah is much shortened. But yet they still have the same structure super fastinating. Anyway a side note, right I was fascinated by that. Great recommendation by David, a book of the things that we've discussed here today. Ladies and gentlemen is available just go to outcomesrocket.health/archway and you're going to be able to find all that there including the transcript, links to the webinars that I was telling you about as well as Archway Health's website so you can learn some more. David, I'd love if you could just close us with a parting thought and then the best place for the listeners could get in touch with or follow you.

Sure yes. So I would say just that the theme of this, for providers on the on we're listening or are they are listening. It's a great time to be pursuing these initiatives and particularly I'm obviously biased here but yeah the bundle payment programs for especially organisations. The risk is relatively limited the opportunity can be can be meaningful the learning is significant just to be a look at the data. Compare your performance to others, understand where there are opportunities for improvement work with or health to work with a specialist you a specialist organisation work with you or your hospitals and your post providers. There's just so much opportunity for improvement and it's so accessible in these programs that it's time to get started and then for employers, I would say there is a big difference from one provider to the next and the ability to kind of look at this information and help your employees find the best specialist, they can improve the outcomes of who the patients experiencing the help get your employees back to work faster when they had some sort of sickness or injury and it can help you you know reduce the costs. It's really everyone wins in that scenario so it's a great time to be thinking about this it is still early but it's too early to get started because we think it's very important.

A great message and what would you save the best place where the listeners could follow you or reach out to you?

Yes. So as you said Saul, our website is archwayhealth.com. I'll give you my email address, dterry@archwayha.com. We have a general email email inbox info@archwayha.com and we love, as you can probably tell,we have the fact folks about this but your provider organization or a pay or a player looking to drive improvement, you have to focus..

David, thanks so much for your help and your contributions here today. It's been a really fun conversation and I know that it's going to make a big impact for the listeners in their approach to bundled payments. I just want to send a big thank you your way.

Well thank you all. Thanks for including us this has been a I really enjoyed the conversation. You're obviously you're also very passionate knowledge about this area and the type folks with us to talk to you. Thanks so much.

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

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Recommended Book:

Moby Dick

Best Way to Contact David:

LinkedIn: David Terry

E-mail:

dterry@archwayha.com

info@archwayha.com

Mentioned Link:

Archway Health

BPCI Advanced Webinars

Episode Sponsor:

Using Technology to Transform Healthcare Delivery Models with Matthew Fenty, Director of Innovation, Strategic Partnerships at St. Luke's University Health Network

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

Welcome back once again to the outcomes rocket where we chat with today's most successful and inspiring health leaders. I have an amazing guest for you today. His name is Matthew Fenty. He's a director of innovation and strategic partnerships at St. Luke's University Health Network in Philadelphia Pennsylvania. He brings passion and perspective to the dynamic intersection of health systems, life science and technology with a focus to transform health care delivery models through an innovative use of technology. A system search approach to design thinking and iterating on legacy business models. His perspective stands from a significant experience with healthcare and life sciences sectors spanning end to end healthcare delivery including translational R and D scientific informatics and analytics, due diligence corporate development product operations strategic planning and execution technical product management and digital health technology and adoption. I had the pleasure of meeting Matthew at a health care meeting and I was just blown away by his passion for health care and I thought man I've got to have this guy on the podcast and he was very generous with his time. So now I have the pleasure of welcoming Mr. Matthew Fenty to the podcast so Matthew welcome.

Well thank you very much. Not a physician that I wasn't playing early on but nothing more. On the technical side kind of behind the scene is the way to go.

Matthew you have a doctor and results in my eyes and that's why I wanted to call your doctor you know. But definitely a pleasure to have you on here. Matthew is there anything that I missed in your intro that maybe you want to fill in.

No I think you covered it quite well. Just one other comment. So we are actually based in Dublin Pennsylvania. It's about an hour north of Philly. But we do span this entire area. So you know one little while OK. Yes.

Now good clarification. Appreciate that. What got you into health care to begin with Matthew?

Yes sure. So you know health care has really been kind of a passion of mine you know going back to a grade school, elementary high school. I think a lot of the folks in your podcasts have always had that passion for health care either kind of behind the scenes or frontline medicine. It's always been a big focus of mine. And you know think about it in my undergraduate days very much focused on bench science kind of more analytical behind the scenes. I think you know kind of you or other some of your other guests thinking about going into medicine seeing where that takes and kind of taking a step back and say you know on the provider side kind of boots on the ground isn't the right path but there's a lot of opportunity a lot of I think work to use my skill set to kind of think about how do we improve operations and how do we improve the business and the kind of the nature of health care and medicine and care delivery and that's kind of really my passion. So kind of what you alluded to. I've been in the translational R and D side, at wet lab, pharmaceutical operations strategy. Now on the provider side and really I think there's a lot of opportunity to take those different perspectives and I think how do we fix and how do we improve this entire beast of healthcare delivery and medicine within the country.

Matthew that's such a great summary and appreciate you sharing that. Some meandering road that got you to where you are but very focused in your case. What would you say today is a hot topic that needs to be on every medical leaders agenda and how are you guys addressing it?

There's answers I can think of you know easily hot topics and precision medicine you know makes things like that early. I think one of our big focus and you know a big focus of mine is adoption and changing management and kind of supporting our clinicians, our leaders for change that's happening regardless of if it's new models of care delivery, new economic models of care delivery ways that we engage with our patients in a remote or virtual setting but it ultimately comes back and stems to how do we get people to adopt change and how do we get patients to think differently and help them manage their own health care. How do we get our physicians and our clinical teams to redesign what they're doing and how they deliver medicine. And a lot of it goes back to change management, education workload change, engagements by and support. These are health care types of issues. It's really you know there's a lot of change happening some mandated externally through policy but a lot of it is you know we need to prepare for how do we go back to care delivery and how we go back to the human touch of medicine. And it's a big effort. And you know I think if we focus on those outcomes like precision medicine and genomics et cetera we always need to go back and say How did we get this to work and how do we scale this within our health system?

Now that's really interesting Matthew. And what do you think is at the center of change management. How do you move the needle on that?

Yeah. It's a trick and it's really kind of it takes a team you know a lot of it goes back to organizational readiness and thinking about engagements of the people that you need to work with. And so it's communicating, its understanding and translating why change is happening. Think about why successful EMR launches have been so successful but is it because of the technology. No you can look at and read in the news a billion dollar or 500 million dollar failures in a very public launches. Mars, they think about the ones why things were successful and why things were not in my perspective my point of view a lot of it doesn't have to do with the technology or the systems. It has to do with engagements by and and communication. And if you can get your frontline staff and you can get your physicians and your administration and patients all kind of thinking about why change is important and health benefits them in a way that it makes sense in a way that they can kind of pull it in themselves. That's the only way that I think that you can really have successful adoption of new processes new technologies new ways of evidence based medicine protocol delivery. It's been able to articulate why something is changing and why say impacts me versus why it impacts you.

That's a great call out Matthew. And you stress that the beginning of the interview the importance of operational excellence and you know the theme that keeps coming up is just communication rank communicating the relevance of this the why and then the how. And you'll get to that end result that you and your organization are looking for.

I think you know we are it's an industry that we're in that you don't go into lightly and you're not. It's a very self-selective industry to be in healthcare and we're all in this to really improve patients. Now I want to improve experience. When my mother goes to the hospital that she has both the best care as well as the best experience,.

Yes.

And that her care team are physicians and her nurses and support staff. They feel part of the team are compassion and kind of the human touch is back in the healthcare. It's not a machinist on an operation it's not a process or checklist that this is really how do we get people to go back to the practice of hand touch, human touch medicine and you know we can do that with technology but a lot of it has to do with educating and get people to really think about compassion and empathy. And it's a lot of work and it's a lot of things that we all want to do and this is why we're in the industry.

Yeah it's a really great call and you know a lot of people talk about Matthew like hey you know what. Why can't health care be more like hospitality like when you walk into a hotel. The front line staff smiles at you and they receive you they take care of you, their service. Why can't it be more similar. Like what's the gap?

Well that's the million dollar question I think if you ask is you're going to get wildly different answers and you might ask a physician say a trauma doc in the E.D. his job isn't to make you smile, his job.

That's true.

Her job is to keep you from dying on the table and then they can think about there is the inherent difference of a sort of a pure service industry where at the luxury of that organization that they're getting that customer with think about the job and the goal which isn't really highlighted as much as it should be is to treat patients who are who are dying. It is to find the best care to support patients at the end of their life. There's ways that we are interacting and working with our patients and their families that is in a hospitality type of relationship.

Right.

Now with that said, we do need to think about how do we put the human touch and how do we make it more empathetic. So when patients are calling us and they're concerned about their bill, they could be thinking well you know maybe they lost her job or maybe their parents are dying or have recently passed away or maybe their kids you know just got diagnosed with something. And so ends up being you have to put that and retrain staff and retrain some of our any frontline persons to think about this is the most intimate point of relationship that you have with your customer with your patients with their family. And they don't necessarily want to be working with you. When I go to the doctor, that's one of the least happy things that I want to do in my day. Something's wrong. I feel sick.

I agree.

I or my parents in the hospital. It is a high stress, high type of emotional environment. So we need to make sure that our people are ready and equipped to deal with our customers and our patients in a high emotional type of setting. And I think kind of go back to your point, it's not going to be a hot the pure hospitality type of mindset. But choice how do we put empathy back into health care for anyone who interacts with patients or their families. Or you know with anyone who's part of the care team.

Now that's a really important distinction Matthew and I'm glad you brought it up. Definitely not a place where you go to get a smile. You get at a hotel right if you're broken they're going to fix you the bones or whatever you know your heart. So I think that's very very great distinction to make. But let's find the empathy. So can you talk to us a little bit about some of the things that you guys have done and maybe some examples or things you've done to create results or improve outcomes as it relates to this?

I mean sure, as you know as it relates to empathy you know a lot of that is. I wouldn't say that's that's innovation that's education. That's things like how do we get our patients to be able to speak with our staff in a non-clinical environment? It's having a patient centered forums and bringing in patients who talk about their experience to talk about their patient journey so that our staff can understand holistically what's going on when a patient either say a newly diagnosed patient with cancer or maybe someone who's recently pregnant. We want to know kind of what is what's going on and what's your journey and what's your experience like so that we can help reshape what we do retool what we do help kind of meet your expectations and exceeding expectations as well as provide the best clinical care and services that we can offer you. So when we think about things that we've actually done so you know we're really focused on our key patient populations ones that have very complicated patient journeys. Not your come in rate fixed types of things so could be things like your maternity or obstetrics types of patients oncology pediatrics states that are high super high stress and super ambiguity in terms of what's going on. So we're putting in technology we're putting processes we're putting in kind of people to help support patients in these care journeys in these kind of these pathways that they go through. So that could be from outside of technology innovation or profit innovation that's where managers and nurse navigators and kind of people helping you navigate all the different paths that you have to go through to come and see our physicians to see our care team. We're also technology enabling a lot of those services. We can think of patient journeys in unstructured in prenatal planning a lot of it is how do we ensure that we're providing digital access as well as physical access to our care teams so that when our patients need to access our services or have questions or have general anxiety about what's going on, they can reach us on the phone, text message, e-mail, chat, video-based. So providing multiple points of digital access to anyone who has a question or concern about their condition, their parents or themselves have a way to reach out to us.

Now these are these are definitely important, right? You want to make sure that you feel like you're not on an island as a patient. Sounds a yes I've been very mindful about how to give patients more than just one way of getting in touch digitally and physically. In your journey. Matthew have you had any particular setbacks that you've learned like key learnings from that you want to share with us?

You know I would say key learnings is the upfront education the upfront diligence the communication and with your end users and stakeholders, whether that's you know having focus groups of patients. Or having focus groups and kind of workflow sessions with your clinical staff or operational staff. It's thinking and being very mindful of what solutions you want to deliver as it really impacts and aligns with what is currently done now and how should we redesign that workflow in the future. We're then engaged into the future and if we don't have that by and if we don't have that strong operational engagement from whomever that end user is and there could be patients or it could be our clinical staff or frontline staff or back office staff. Having that by and up front as early as possible is the only way that you know be successful and we've had some the projects initiatives and pilots that now haven't been successful. And it's not because of the technology it's not because of the idea it's because there hasn't, there wasn't a clear expectations in the beginning, there wasn't clear operational buying. Now we might give a tool to a patient but if they don't know why or they don't see why it aligns with what they need it's going to sit on the shelf. And I think that's similar. You know regardless of industry, our job is to provide the best way that we can help deliver services in our physicians or our staff to our end users and our patients that we don't be very mindful. Be very empathetic and have those discussions with the entire value chain and people and things are going at work. And you know we're going to say well the technology didn't work or we didn't hit our end goals and our objectives. But really it goes back to the beginning, engagement, communication, by an acceptance of change.

Matthew great lesson that you shared with us there. And listeners and you know it's a great point and you can't throw technology on top of a broken process or a misaligned interests or lack of by-in you get to achieve all those first. And that takes time and I think a lot of us want to hit the easy button and just throw some technology on top of things and it doesn't work that way. And this message is really poignant message for not only providers but also technology companies and device companies life sciences companies, you can't just throw your solution on top of broken process, you've got to work on that. Get the buy-in first. What a phenomenal lesson to share Matthew, really appreciate that. So what would just say one of your proudest medical leadership experiences has been to-date?

Well it's really I think getting our organization thinking about change and thinking about what's possible and thinking about how do we collaborate and how do we make sure that when we're looking at change or we're looking at putting in systems or technologies that we're thinking about it holistically kind of enterprise wide or organization wide and not just individual hospital or individual service line or individual practice because you can think about where the majority of health systems were maybe 10 years ago. Smaller, fewer hospitals many more private practices kind of individual decision making and lack of coordination. And so where we are in our maturity of critical coordination. we manage you know 10 acute hospitals with more than 300 physical locations in our area and our patients are very tightly within our scope of clinical care. So by our very nature there has to be significant collaboration and coordination between all of our locations, Family Medicine specially allied health. And so having our clinical leadership as well as administrative leadership thinking about scale and how do we take a piece of technology or service or product and have that scale to multiple patients, multiple service lines and really you know one of our big wins. I would say is that recently we we're putting in a secure communication capabilities within our clinical staff that ends up just being secure text messaging and you can think about you know this is a market mature capability and this is the things that have been around for many years. But what we haven't done is really think about how do we look at communication and clinical communication as a network or as an enterprise type of function. You can think about where we were in many health systems where they are now of having individual points of communication routing messages to operators using pagers, being on hold for hours in a day trying to track down providers. And you're kind of your care team. What we did is say hey let's do a small pilot of 2500 people a base of a size and say we're going to put a piece of technology and we're going to get people thinking about what's even possible. And so going back to innovation, adoption. Sometimes it's it's very difficult to understand the value of a piece of technology or innovation until you start playing with it until you stop using it and the boots on the ground.

Then you can start getting people to say hey this is really important but if we tweak it this way and it's even much more important ten times as valuable so what we typically do with our with our pilots who are kind of we call Phase 1 deployments or phase of launches it's to get a very narrow core group of individuals checking out a piece of technology and saying here's why it will benefit our organization. And then they're going to be the champions. They're going to be the stakeholders and they're going to be the ones buying and selling it through their peers across the organization. So from a communications perspective we realize that this was a significant opportunity within our organization to improve all communications. Things like console's a critical page alerts like rapid responses in codes and milers Sroka alerts in a way that our clinical staff at the functions that we have are physicians cover all of our facilities. So you can think of a much larger system or even a smaller system where physicians are only deployed at one hospital. The nature of our area that our physicians cover all of our hospitals and all other services. So we need to be very tight and very nuanced in how we do communication especially when we do things like Kotzer alert. And so we are completely redesigning with support of our entire clinical leadership staff and operational staff. If we could redesign this in the future let's forget everything that we do now. What would it look like and it takes that level of buy-in innovation kind of help perturb the pot and kind of say here's what's possible. Then they going back operations say this is a great idea. This is how the ancient run with it.

That's interesting. So in your vision Matthew, what does it look like 10 years from now if you guys could build it.

That's a million dollar question. You know things are changing so quickly so you know you can think 10 years from now in terms of value-based care or provider rates contracting things like that that you know the economics of healthcare is incredibly going to be different. I think the way that we engage as a provider network, engage with our patients outside of the four walls of our facility is going to be drastically different. Now there's a lot of adoption of telemedicine, types of capabilities within health systems and in my view that's kind of table stakes at this point. So that's like Telad stroke, telecom faults, Kelud behavioral health and just the way that we think about the point that it helps us scale our physicians to hit a much broader patient population especially if you're thinking of things like stroke or.. Now we need to have that diagnosis instantaneously and maybe our patients and our way are two hours away from a physician but we need to make sure that we're doing eye care. So I think the way that the technology's becoming more mature that helps us scale are impact and our reach to treat and manage patients wherever they are either within our facilities or outside. And I think kind of lastly, there's a lot of technologies and lot of things that we're considering to improve just basic operations. So how do we streamline care delivery. How do we streamline documentation. How do we make sure that the encounter with your physician. You know it's not a permanent encounter whether it's 9 1/2 minutes of them typing on a piece of paper or typing.

Yeah, that's a great point.

We want to put that human touch in that connection back into the visit. And so what can we do from a technology perspective to streamline that to do as much of the behind the scenes as possible to let our physicians be physicians and let our clinical staff do what they're trained to do and what they want to do.

Now beautifully said Matthew you're asking all the tough questions and tackling some really pertinent issues. I'm excited to even continue the discussion outside of this podcast with you and because there's no doubt in my mind that you're thinking about these very difficult issues. Tell us a little bit about an exciting project or focus that you were working on today?

Yeah I mean I think I'll go back to the communications one because it's a valuable project. Really thinking about this is not just communications. It ends up also looking that if you're a physician, imagine a scenario where you're the E.D. trauma Doc and you need to find the on-call or the you need to do a consult with orthopedics and consult cardiology and consult with the behavioral health.

Yes, okay.

What we currently do and what most physicians do is what we call the operator they find who is on call and they might track down people. But what we're doing is saying can we blow up the entire thing and make communications completely self-service for staff. And so it ends up being how do we blow up our operator call center. How do we make all of our encore schedules easy to view.

Like a dashboard of who's available. Yeah.

So what we do now.

That's cool

So we have a dashboard also linked within our text messaging system. So right now you can text the hospitalist who's covering the 5th floor in a main hospital. You don't need to know who they are. All you needed knew as a physician I needed to reach the hospital who is covering the patient on the fifth floor. And so what we've done is redesigned the workflow to allow our clinical staff and support staff to be able to outreach and communicate directly with those types of clinical roles.

That's awesome.

So that thing is like our patient transport center or care management or behavioral health toxicology. So if you need to rapidly communicate with the One toxicologist who we have working within the organization, it doesn't matter where they are. You can send a text message to toxicology on-call and they get that message instantaneously wherever they might be.

Amazing.

So that allows us to completely redesign how we do things that console and patient transfers and transition of care between their hospitals and it's gold message, so it be. It allows us to shrink that time that it takes to make that clinical decision seconds or minute versus hours. So we don't think about this as an enterprise function or holistically. What are all the nuances of communication. And you just put in a texting system, you're only going to scratch the surface. So ends up being you need to get significant operational engagement from all of these different functional areas from different clinical areas that say hey, we need to be managing this and look at this big picture. And I think that's something I always push back to your listeners and to any of the innovations that we want to put into place. Is that how do we get the capability to scale enterprise wide? And what will it take operationally technically as well as boots on the ground and who's going to own it and how is it going to be governed. Because what we want to do is make sure that we have significant impact with the technologies or process that we put in place not just at the good presure release. Or it's interesting technology but there's no adoption there's no long term value. So we always want to push back and say operationally who's going to own this and how we're going to maximize the value of some of these technologies that we put in place. And without that buy-in that operational engagement stakeholder management that things are going to sit on a shelf or do nothing to be used to the fullest potential.

It happens so much things sit on the shelf so often that the words of wisdom that you're sharing with us today Matthew are just hitting home with me as I'm sure it's hitting home with a lot of listeners. Listeners, don't worry we're at the end of the podcast here. Matthew will share the best way to get in touch with them. It's something that he said resonated with you, maybe you want to collaborate with him. We'll give you the best way to get in touch with or follow him at the end here because we are getting close to finishing up today. I always wish I had extra time but these 30 minute slots are are short of that sweet spot and listeners, time frame commutes and all that.

They did go by quickly.

They do man. I mean it's amazing. So let's pretend you and I are building a medical leadership course on what it takes to be successful in medicine operations, the 101 of Matthew Fenty. We're going to write a syllabus. I've got four questions for you lightning round style followed by your favorite book that you recommend to the listeners. You ready?

Sure, sounds good.

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

Connection. connection with your patients, connection with your peers, connections with patient's families. Because it's a team effort and if you don't fully engage your clinical team and your patient's family and personal support team then things aren't going to work well. It could be things like did the patients get to the appointment on time. And so maybe it's you know it's their children or their parents are helping them doing that. So having that connection with everyone is part of the patients care team needs to be a part of it.

What's the biggest mistake or pitfall to avoid?

I guess the opposite going rogue. But really it's thinking that the patient knows what's going on. So you know personally I've been to the hospital before they get discharged in the emergency room when I've been to the emergency room. And you walk out the door and say what did the doctor want me to do. What would happen next and a follow up, when the next step, what do I need in terms of medications and going back to what I said earlier this is a high emotion, high stress type of environment that we put patients in. So thinking that the patient is a type A person who is completely literate know medically literate who is only focused on what is my next step. That's a big pitfall. So you have to be very empathetic of what's going on in the patient's head. Now maybe they don't understand, maybe don't speak English well maybe there's other things going on behind the scenes so not being able to sit in the shoes of your patient is. No I think going to be a major downfall.

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

It's relevancy is I think a couple of different areas it's you know you have your clinical relevance and you're not seeing evidence based practice in medicine. And I think you know that's something that people takes for all health systems to have to do. I think from a from a technology side and innovation side here that's kind of the bread and butter within our organization working stage 7 organization most wired. So from an organizational readiness perspective and technology and how do we leverage technology is really in the minds and culture of everyone within our I.T. organization. So relevance, you know that's going to conferences that's listening to podcasts like yours that seeing what other organizations are doing and being able to think about how do we adopt that here? And it could be something for another sector to be from a consumer CPG, from end it from insurance from the hospitality and say you know that's a really interesting way of doing business. And that's a really interesting capability. How do we get that type of thinking internally? And I think that relevance is that always push for learning is relevant. Whether you're a provider or even if you're on the IT side.

Interesting, that's a very interesting point. What would you say is one area of focus that drives everything else in your organization?

Well from an organization perspective I think quality quality and access. So we very much focus on 3 pillars within our organization. Quality, access and cost. And so when we think about either technologies or clinical processes, there's a big laser sharp focus on how this is impacting or improving our patient access to our system. How improving total quality outcomes, long term outcomes, short term outcomes. How are we looking at value-based care and value-based contracting as well as how do we ensure that we are providing the appropriate cost. How are we ensuring that we're managing those costs. Because we do realize that I think as an industry that health care costs are going up and it is in our interest to ensure that we're providing a service that our patients and our customers continue to use and afford. It ends up being costs and price transparency as well as quality and clinical goals as well as access to services as always everything that we do either from a process or technology or innovation, always aligned to one of those goals.

Outstanding. What book would you recommend to the listeners?

That's a hard question. There's a lot of things I read that actually aren't books so a lot of like blogs from physicians, articles blogs, a lot of blogs from the venture space who have interesting perspective on healthcare. So you know I was always for an education or learn and read those types of blogs I can share with you some of the ones I check out weekly or monthly. It's a really interesting book. I really like the Google Ventures design Sprint book because a lot of it what that does is get people to think about problems and opportunities. And how do you articulate what you're trying to tackle and not trying to identify solutions. So a lot of what we do internally is exercises and discussions to really identify and need the value of a business processes to change versus what's the value of a new tool or new piece of technology. So that book really helps us kind of get that frame thinking and then I think on the other side I really like The Martian that's a fantastic book. It's really funny. I think it's a lot funnier than the movie with Matt Damon that anyone who has you know a couple hours to kill. You can blast of the Martian pretty quickly.

That's a good one. Matthew great recommendations. Listeners, you don't have to write any of that down. You could find our entire show notes the transcript today's interview as well as all of the Q&A and links to the resources that Matthew just shared with us. Just go to outcomesrocket.health/fenty, F E N T Y, it's Matthews last name. You will find all that there. So this has been so much fun Matthew. So glad that you made time to do this if you can just share a closing thought with the listeners and then the best place where we can get in touch with you?

Of course I appreciate the time on your show. I would always, regardless of where you are within healthcare either pharma, in a provider research. Think about we're in this for for us and our parents. Think about how does what you're doing is going to improve the experience for your parents or for your children. And so I'm putting empathy and putting that personal experience and personal touch in research or drug discovery or surgery or behavioral health or care management. At the end of the day we are treating our family and our friends and our neighbors and our community and healthcare is such a local type of industry that we're going to see people that you know work that come in. Are you their services on a daily basis. So we want to make sure that we always put that human touch a human focus back into what we do and that every decision should be based off how is improving our community and how this improving our neighbors.

Great message Matthew. And what would you say the best place for the listeners to follow you or reach out to you is?

E-mail me directly. I'm pretty accessible. I don't tweet a lot. I follow a lot of people who tweet a lot but my social media it's, also in LinkedIn or e-mail or just a phone call would be always the best way to reach out to me.

Beautiful. Well this has been a ton of fun. Matthew really appreciate the words of wisdom you've shared with us the tips on operations, the tips on just putting empathy first and some of the examples that you guys are doing there at St. Luke's, really inspiring. So keep doing what you're doing man. This has been a really fun episode. And we're looking forward to staying in touch with you.

Of course. Glad to help.

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

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Recommended Books:

Sprint: How to Solve Big Problems and Test New Ideas in Just Five Days

The Martian: A Novel

Best Way to Contact Matthew:

LinkedIn: Matthew Fenty

Email:  matthew.fenty@sluhn.org

Mentioned Link:

St. Luke's University Health Network

Episode Sponsor:

Outcomes Rocket - Jim Rickards

Understanding the Power of Coordinated Care Organizations with Dr Jim Rickards, Senior Medical Director for Population Health and Delivery System Collaboration at Moda Health

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

Welcome back once again to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I thank you again for tuning in and I welcome you to go to outcomesrocket.health/reviews where you could rate and review today's podcast because I have an amazing guest and a great contributor to healthcare. His name is Dr. Jim Rickards. Dr. Jim Rickards has a wealth of experience in the healthcare sphere. Currently he serves as Senior Medical Director for Population Health and Delivery System Collaboration and he's also an author and thought leader in the space over in the great state of Oregon. He's doing some really interesting things to reshape the way healthcare policy is and really focused on strong strategic direction in what the state of Oregon is doing and so what I wanted to do is open up the microphone to Dr. Rickards to fill in any of the gaps of that introduction and give you a warm welcome to the show. Welcome, Jim.

Yes thanks, it's great to be here. Appreciate the nice introduction. I selected just kind of highlight the fact that here in Oregon we're doing a lot in terms of healthcare reform especially in the Medicaid space and we've been pretty successful over the last five to six years in changing how we pay for Medicaid with our coordinated care model of care hope to touch on that throughout the program.

Absolutely Jim and we definitely want to hear a little bit more about that you guys are ahead of the curve as it relates to that and what is it that got you into the medical sector to begin with?

Well from a physician a radiologist by training so it's a physician who interprets medical imaging studies like CTs and MRIs and I was always just kind of interested in science and biology and what attracted me to radiology was just the fact that it really allowed you to kind of apply your core knowledge of anatomy and physiology and pathology without having to deal with a lot of the kind of more burdensome aspects of medicine like administrative complexities pre-authorizations which is kind of funny now because that's kind of the space I operate in now working for a health insurance plan. About seven years ago actually I kind of started moving out of the so-called dark room of radiology and into the healthcare payer space largely because I was becoming a little bit frustrated with my practice of medicine. It wasn't for the usual reasons you hear of declining reimbursements or increasing administrative burden. But I was getting frustrated because those feeling I was getting to know my patients a little bit too well. And I would say that most people are kind of taken aback and say oh you're a physician you're supposed to know your patients well and they say yeah if you're a family practice doc or an OBGyn and caring for a pregnant woman then by all means you should know everything there is to know about your patients. But as a radiologist the way I practice medicine is with high cost imaging exams which actually expose people to radiation. And so I was frustrated because we had so many so-called frequent flyers in my small town in Oregon. And I was questioning whether or not I was really delivering value to these individuals by reading you know multiple repetitive C.T. scans or MRI scans. Week after week on the same people and so I needed a way to to try to help these folks but it wasn't medical care they need. They needed help with their health. But what I started to learn was that so much of our health is determined by things other than the medical care we receive. Term by things like our behaviors or our peer group or level of education. All these so-called determinants of health. But as a physician, I didn't really have a way to impact these other areas. And so that's why I was excited in Oregon when we started to think about how we were going to change the way we paid for Medicaid and develop what was called the coordinate care model and basically it was way start looking at how can we pay for and govern all those other elements that impact an individual's health that aren't medical in nature. But think about behavioral health aspects, the dental aspects, the educational aspects. And so learning about that model what kind of attract the a healthcare administration and eventually moving on to make firm position as a medical doctor without insurance company.

That's pretty interesting Jim and listeners if you haven't heard about it Jim wrote a book it's called Our health plan :community governed health care that works. In it, he takes you through this topic that he's just discussed with us. The coordinated care organization the CCOs. Jim, maybe we could dive into that a little bit. Widespread are the CCOs and what's that looking like ten years from now?

Yes. So usually when I start talking about the CCOs I'd like to take a step back and just remind folks that in the U.S. basically there's three ways we pay for health care. There are all types of health insurance but in general there's three types of health insurance one there's commercial health insurance which individuals receivers employee benefit through there from their employer or they may purchase it on the exchange as an individual plan. So that's one type. The second type health insurance is Medicare that's health insurance available to individuals 65 years of age and over just by virtue factor 65, the cost associate of Medicare paid for by the federal government gets a little bit complicated and that there's parts ABCD of Medicare but I don't think we need to get into that. Then the third main type of health insurance is Medicaid and that's health insurance for economically disadvantaged individuals. If you're in one of the so-called expansion states and you earn up to 138 percent of the federal poverty level which is around 13 to 14000 that are here for an individual and you qualify for Medicaid benefits and the delivery of Medicaid benefits is largely up to the states. Now the federal government helped pay a significant amount of the costs associated with Medicaid but the states are in large part responsible for administering the benefits. Well in Oregon back in 2009 - 2010 we were having some challenges with our Medicaid program. We were facing about a 2 billion dollar budget deficit, the state budget deficit largely driven by cost associate with Medicaid the quality outcomes associate with our Medicaid program we're now what we wanted and Medicaid members were having difficulty finding access to care. So we knew we needed to change the way we delivered Medicaid benefits. We've had some managed care entities delivering benefits across the state but the system was pretty fragmented. There was really no coordination of various benefit providers from medical to be here to help the dental and a large number of the recipients also receive benefits directly from the state and the so-called fee for service system. And so while there were payments being made for Medicaid services again the payments weren't coordinated. There wasn't one single mission and vision for what it meant to have a healthy community of Medicaid members. There were no common. There was no common set of metrics to see how we were doing in delivering benefits. There was no one global budget for a community to try to manage to try to control spending around Medicaid benefits and there was certainly no way for Medicaid members or providers to give input or to have governance over Medicaid benefits. So the system was very fragmented care was siloed and it was really kind of inefficient. And so we decided and Oregon was that we were going to revamp the way we deliver Medicaid benefits and the state passed some legislation. We work with CMS to get an Olympic team waiver and we created what was called the coordinated care model and basically the foundation of the coordinated care model was the development of a new type of organization called coordinated care organization or CCO seashells or similar to organizations that probably most folks are familiar with hold ACOs or accountable care organizations. Now they're different in the fact that they go further in that they don't just pay for and deliver medical benefits but also behavioral health and dental benefits under one global budget. And they're also governed by the local communities that they serve. And so my story was I helped start one of these CCOs and the community I lived and being an actively practicing physician and seeing the need and the benefits of such an organization.

Jim, supercool that you did that above and beyond your call of duty but it's something that you took on as a mission and that's what the leaders listening to this podcast do. And just like our guest just like Jim here and in our previous guest right you do more than your calling to create those solutions for the folks that need it most. And you had some success in creating that. And what would you say today has been some of the benefits that have been derived from the community through this CCO?

Well so now across Oregon about 90 percent of all Medicaid members receive their benefits through with the CCO. So we have 50...

Wow.

Across the state care. Yeah. So it's huge like the model has really transformed the way that we pay for and deliver Medicaid benefits that are arguably the most challenging population there is. And so some of the big benefits have been for one the CCOs was our community governed. So now there's much more active participation in the development and delivery of Medicaid benefits than ever before. So each CCO has a governing board the governing board composition is actually laid out in state legislation. It has to have individuals on the board such as local elected officials local hospital administrators and actively practicing behavioral health provider and actively practicing primary care physician. So these organizations really have true broad based community input which again it's a little bit different than an ACO in charge or mainly governed by health care systems and medically focused is the CCO model goes much further by including those other individuals from the various parts of the health care system that aren't necessarily medical in nature. So I think one key success is very foundational in how these organizations are governed and organized and the fact that we've been able to stand up 15 of these organizations you know looking at some numbers or some more kind of quantitative or objective measures of their success. I think a big one is this number of 3.4 percent and basically that means that for every year these CCOs have been in existence they've been able to keep their annual trend rate increase at 3.4% or less so in other words the health care spending increases for the Medicaid population annually it's only been three point four percent for the five years the CCOs have been in existence which is really tremendous. I mean if you think about it. Yeah that the most challenging arguably most expensive members of our population we're able to control the health care cost increases associated these numbers by simply delivering care in a different fashion through the CCO. And I know that the ability to maintain that the cost increases has not come at the expense of quality but it's actually come about as a result of increasing quality. And one of the main reasons or ways we've increased quality is to dramatically increase the number of Medicaid members who are enrolled in medical homes. So in Oregon we have a really robust medical home recognition program called the PCPCH or patient centered primary care home program. Essentially the Oregon Health Authority which is a division of state government recognizes primary care clinics for being medical homes. We now have more than 90% of all Medicaid members enrolled in a medical home where they receive their primary care. So that's really been key to helping control costs while increasing the quality of care delivered for our Medicaid members. You know before the CCOs were around we had very few medical members that could even get access to a primary care physician. And now we think about it more than 90% are enrolled with a high functioning recognized medical home has resulted in better outcomes in lower costs.

That's outstanding. And kudos to you and your team Jim for having put this together. I mean healthcare is tough enough but you went even further you knew impacted policy and implemented what you guys set out to do and just want to offer you and the team that you work with. A big congratulations.

Yeah thanks. It's really been the effort of course of hundreds of people across the state all over different communities and you know really what the CCR model did was it finally gave so many of our communities and so many of our health care leaders and our providers permission to work together in a different way. You know before the CCL model was around as I was saying before payment for health care services was siloed and fragmented. But now with the Speciosa we currently have 15 of these CEOs and essentially each CCO receives a global budget for the number of members it serve or in other words it receives a Per per month payment for each individual responsible for covering. And then the CCO takes this global budget really PM PM from the state. And then it uses those dollars and as I risk for those dollars possible managing those dollars and providing medical behavioral health and dental care services. But before the CCO model before those dollars flowed the community before we had this board structure that was inclusive of all members of the health care system there wasn't that framework, there wasn't that permission for communities to do things like we've been able to do here in Oregon. So I think that's really been crucial in allowing us to be successful.

That's outstanding and an inspirational story. Now it wasn't always easy, it wasn't always a success. Jim maybe you could walk us through a setback but you had that maybe other people trying to influence health policy can learn from.

Yes so when we started the CCO model a lot of the different parts of the delivery system that were being pushed to work together really had had never worked together so public health departments it never really worked closely with primary care physicians radiologists such as myself and never really worked closely together with dental delivery providers. And so with that it was challenging to learn how to develop relationships. But part of structure of the CCO really supports the development of relationships among these various types of health care providers that didn't really work together previous to the CCO model and one of the ways we're one of the parts of the CCO structure that allow that to happen was development of what was called the Clinical advisory panel or CAP so most CCOs have a clinical advisory panel that's a governing arm made up of the various providers in the community and in the CCO that I was involved with the anthill CCO when we started the CAP or the clinical if as you panel one of the first things we did was we asked our providers you know what were some of the challenges they had and in terms of delivering care to the Medicaid members and rural Yamhill County where I was practicing we had challenges with access to specialty care we just didn't have a lot of various specialists in the county. One type of specialty in particular we were limited with was dermatology. So physicians who deal with skin issues we only had one dermatologist in the county and who was nearing retirement and didn't see a lot of Medicaid members and our primary care physicians told us you know we need to have more specialty dermatology care. And so one option would be Welkin the CCO work to recruit a dermatologist. Well there's not a lot of dermatologists out there fewer than 400 come out of training every year. So that's you know almost one for every million Americans. The ability to recruit run to rural Yamhill County was not very likely. Typically dermatologists like to go to more.

Urban city.

Affluent areas and where they can do various cosmetic services if needed. And so we had this challenge. Well we really need a dermatologist. We probably weren't going to attract them here. They are very expensive also to hire. So what we did was we decided we would leverage technology to get access for our Medicaid member to Dermatology. This kind of came about as a result of my familiarity with the way medicine be practiced. You know I've been practicing teleradiology essentially my whole career. Really what that means is I'm able to sit at a computer anywhere any time and look at an image. It might be a CT or MRI and I can apply my knowledge and skills as a physician and interpret that image to come up with a diagnosis and treatment. While I knew that the practice of Dermatology was very similar to radiology and that most dermatologists about 90 to 95% of the time to make a diagnosis just on visual inspection or by looking at a lesion and they don't really need to do a history of physical. And with that they could even just look at a picture on a computer. So the idea was how can we imply employ a Teledermatology solution to help our Medicaid members. And so we look for a national teledermatology provider we are able to find one we contracted with them and we had a some grant money and we were able to buy refurbished iPad Minis and we placed those iPad's in 15 of our primary care clinics. And so now if a Medicaid member has a skin problem and the primary care physician needs dermatology counsel they can just simply pick up the iPad or have someone in their office pick it up take a picture log into the teledermatology company secure Website send their picture to them and then within 24 hours get a diagnosis and treatment back. So literally within six months we were able to go from no dermatology access to having essentially 15 dermatologists with these eye pads and our primary care clinics. But this all came about.

That's awesome.

The challenge of not having specialty care in a rural environment but then you know using the community's voice to identify that problem and then get their help in implementing a solution.

What a great story Jim and kudos to you and your team for that. I mean listeners you either have solutions or you have excuses and you can't have both. And you know a doctor records here and his team are able to do was think outside the box and they found a great solution with some iPad Mini's and an organization that could do it virtually. What a great story. And now the community that you guys serve has access to dermatology because you are creative and thoughtful in your approach. Can you share with us an example of maybe a project that's exciting right now for you.

So since helping start the anthill CCO I've moved on and I now work from Voda Health which is a large regional health insurer in Oregon. And most of my work is focused on a value based care. So value based care is this notion we want to pay for quality and outcomes and not just the volume of services delivered so a lot of my work is geared at helping the provider community or provider networks understand what we're looking for. Help them understand various new payment methodologies we're developing. So we're currently in the process of this monumental shift in health care payment moving from fee for service to the value based care. There's a lot of different types of ways we can pay for value. Several of the key ways in which we pay for value have value based your models in place. One we use so-called performance based payments so we have a number of quality metrics that we build in the contracts in the providers are able to meet certain targets associated with quality metrics they can receive bonus payments. Most of these quality metrics are becoming more standardized. One of the things I typically hear from providers is they're just faced with meeting the needs of so many different payers and have so many different metrics in place. In Oregon we had some legislation passed Senate bill 440 which is working on developing a standard set of quality metrics in the state. We've really tried to align our quality metrics around existing metrics and with that you know a lot of our purchasers now build into the contracts they have with us certain quality metrics so our purchasers want to see colorectal cancer screening or immunization at certain percentages so we then take those targets and those metrics and build them into our contract with our providers. And then if they're able to meet the targets and pay them you know another way we pay for value as we use so-called care management fees. So we realize that there's a lot of work performed especially in primary care clinics that it doesn't necessarily come with the CPT code a lot of chronic disease management, care management behavioral health services. And so what we do is we build in the contract so-called care management fees. We give clinics the cash flow they need to hire staff such as behavioral health therapists or panel managers or social workers to help deliver increased value and disease management and care management capabilities to their members knowing that they can't necessarily build for a lot of those services. So my work is in going out to the providers and helping them understand those models helping them understand what their needs are and then making sure that they were meeting their needs.

Jim outstanding. You're always a couple of steps ahead of what's going on in health care. And it's super cool to hear that you're now tackling the value based care initiative. I know with the mind like yours and your previous success. I'm pretty sure you guys are going to do a great job over there.

Thanks. Yeah and it's a long road. It's funny a lot of this value based care work. It's very easy to see and conceptualize the solution or where we want to go. But being able to implement that across a population of hundreds and thousands of people and thousands of providers trying to get everyone to understand what we're trying to do is take a lot of time.

It does. But you know what you did it before and I know you'll do it again. So it'll be exciting to maybe chat with you a year from now to see the progress that you guys have made.

Yeah.

So Jim getting close to the end here. Let's pretend you and I are building our medical leadership course on what it takes to be successful in medicine. The 101 of Dr. Jim Rickards. And so these four questions that I'm going to ask you are more lightning round style so I'll ask them give me some quick answers and then we finish up with a book that you recommend to the listeners.

Okay.

Ready?

Yeah.

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

The best way to improve healthcare outcomes is really to monitor and track them. You know I think one thing I experienced in my practice of radiology is you know I would literally dictate thousands of just x-rays every year but very few times throughout the course of a year what I actually receive feedback from referring providers are in other ways to see no was my diagnosis and just a heart failure correct or was the right call to say there was pneumonia there as opposed to like this. And so I think having a way to track outcomes and getting feedback to the providers is key and that's something that's still largely missing in our healthcare system. But you know back to our value based care work in trying to track delivery and performance of our delivery system with metrics and targets is one where we're doing that.

That's great. What's the biggest mistake or pitfall to avoid?

That's a good question. I think thinking that you can do it all. I mean healthcare really is a team sport especially as a radiologist for so long I felt like a lot of the burden of delivering and doing all types of aspects of care delivery fell on my shoulders. But with healthcare becoming increasingly complex and with our knowledge of medicine and science growing we really have to acknowledge that it's a team sport and so not being willing to work closely with other folks in delivery of healthcare is a pitfall. So you really have to learn how to be part of the team.

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

Well I think you have to be the organization coming up with the ideas and you have to be willing to fail. You know in general healthcare it's very conservative. You know there is some people say it takes 17 years or something from the time it's discovered to actually be implemented so that maybe a new therapy or medication. But I think you have to be willing to come up with the ideas and implement them and realize that they're not all going to work but you have to hopefully fail in a way that will make you more successful in the future. So learn from those lessons and keep willing to be creative.

I love that gem fail forward guys and what's one area of focus that should drive everything in a health organization?

We all going back to my current work of pay for value or fee for service system was not really set up to pay for value it was set up to help manage transactions and facilitate billing of procedural codes. But I think we really need to focus on value and realize that we're still in the infancy of value based care and it's going to be a long road until we completely move away from fee for service if that ever happened.

That's awesome Jim. Now what book and what podcast would you recommend to the listeners as part of the syllabus.

As far as podcasts I like conversations on healthcare forgetting right now who the folks are that do that but conversations on healthcare is a great one. And then in terms of a book probably recommended Porter's Redefining Health Care from Harvard Business Review. It's a pretty lengthy book but I think it gets into talking about value based care and it has really been the foundation for a lot of my ideas and thinking around healthcare transformation.

Outstanding. listeners don't worry about writing any of that stuff down. Just go to outcomesrocket.health/rickards. That's Jim's last name, R.I.C.K.A.R.D.S. and you're going to be able to find all the show notes, the transcript, links to his work, links to his book, our health plan as well as all the details that we discussed here on the podcast. Jim this has been a ton of fun. We're here to the end and I'd love if you could just share a closing thought and the best place where the listeners can get a hold of you.

Closing thought is I think now in health care there's more opportunity than ever. This was largely driven by the Affordable Care Act. I think things have kind of been in flux now with the new presidential administration. But I think we're well on the road to developing value based care initiatives and ensuring that as many Americans as possible will have access to high quality, affordable health care. So we just say folks involved in this space just keep up your good work it's going to be a long road and there's going to be plenty of work ahead. And then in terms of getting a hold of me I have my own Website. jimrickardsmd.com. You can log on to that or Google that and you can find me and that has links to contact me.

Outstanding listeners again we'll provide that to you in the show notes. And Jim just want to take an extra minute to say thank you so much for carving out the time to be with us today. And we're excited to stay in touch with you.

Great. Thanks a lot.

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

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Recommended Book:

Redefining Health Care

Best Way to Contact Jim:

Jim Rickards

Mentioned Links:

Our Health Plan: Community Governed Healthcare That Works

http://www.jimrickardsmd.com/

Episode Sponsor:

Dennis J. Patterson, D.Ed., is the founder and Chairman of Verras Healthcare International, LLC, an international healthcare informatics firm that creates high-performing hospitals, through physician driven best practice implementation. He has nearly four decades of executive hospital and turnaround management experience in the United States, Canada, and Europe. He has been instrumental in devising and implementing programs that dramatically improved performance in some of the nation’s top hospitals and health systems. He also serves as a trusted advisor to senior executives, trustees, and government officials in hundreds of hospitals worldwide.

What is a hot topic that should be on every health care leader’s agenda?

Value based healthcare.  Providers must be able to use data and technology like Verras Sherlock / Verras Watson Algorithm / Medical Value Index to improve outcomes.

Can you share a time when you had a setback and what you learned?  

Tried to help hospitals as a consultant and realized that it took away from the credibility of the physicians held accountable for results.  The take away:  Empower physicians to make decisions by giving them tools and smart data rather than be a consultant.

What is one of your proudest moments in health care leadership?

Being able to implement the solutions that Verras offers to help many hospitals experience successful value based healthcare and improve their bottom line.

What is an exciting focus you’re working on?

Continuing the work of helping hospitals increase their outcomes and financial value.

In order to make the long term decisions needed to improve healthcare, what should we do?

Go back to when you decided to get into this business and revive your WHY.

Healthcare 101 Course of Dennis Patterson

1. What is the best way to improve healthcare outcomes?

Use objective data guided by staff 

2. What should be avoided in the process?

Don’t believe your own press releases

3. How do you stay relevant despite constant change?

Look at other organizations inside and outside or healthcare to learn from their success.  Interview the fringe.

4. What should be the focus above all else in your hospital/organization?

Keep people out of the hospital.

Recommended Books:

Healthcare Economics – John B. Davis & Robert McMaster

The Company That Solved Health Care – John Torinus

Best Place to Contact Dennis:

verrasldt.com

djp@verras.com

Resources:

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