Improving the quality of life for our nation’s most vulnerable patients
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Successfully Scaling the Care from Home Model with Hank Schlissberg, President of DaVita Health Solutions was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your audio to text in 2019.
Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today’s most successful and inspiring health care leaders and influencers. And now your host, Saul Marquez.
Saul Marquez:
Welcome back to the podcast. Today I have the privilege of hosting Hank Schlissberg. Hank is the President of DaVita Health Solutions. Founded in 2016, DaVita Health Solutions purpose is to improve the quality of life for what they call our nation’s most vulnerable patients, MVPs, the highest risk patients who have multiple complex chronic conditions and high utilization of the health care system with full clinical and financial accountability for the defined set of patients, DaVita Health Solutions goes far beyond DaVita’s traditional Kidney Care Focus to reinvent the care model at scale across a market for the highest risk chronic patients through house calls, Post Acute Care, Behavioral Health, palliative care and other social services. This is on the minds of a lot of us today as health leaders and DaVita Health Solutions has extraordinary impact. With 91% patient satisfaction ratings, 37% fewer hospitalizations, 17% cost reduction and so on. They’re doing incredible work that we’re going to be diving into today. Prior to joining DaVita, Hank was partner at McKinsey and Company where he joined the Cleveland office in 2000 and remained until 2011. He’s had a lot of different leadership roles in health care and it’s a privilege to host him here and on the podcast from Denver where he lives with his wife Carolyn and their three young girls where they love the Colorado outdoor lifestyle. So Hank, such a pleasure to have you here.
Hank Schlissberg:
Yeah thanks Saul, excited to be here.
Saul Marquez:
So Hank anything that you want to touch on that maybe I left that on your intro?
Hank Schlissberg:
No that’s great. I think there’s so many great things happen in health care these days and so it’s fun to be able to talk a little bit about a large story. And there’s so many others that have been featured on your show and others.
Saul Marquez:
Hey Hank. So what is it that got you into health care to begin with?
Hank Schlissberg:
You know a lot of it’s always just the serendipity of consulting. I was working in consulting at McKinsey as you said I didn’t understand health care. I don’t know that I was naturally drawn to it and sometimes just the serendipity of kind of getting staff on a project starts you off and then one thing leading to another is is much more of my story. Now having said that once I started to understand the complexity of the problems that health care presented, the nature of the people that it therefore attracted and then ultimately once I got connected to our patients and what they’re going through I was, I was forever hooked.
Saul Marquez:
That’s so interesting and so from consulting to really a very involved partner in health care with DaVita. What would you say Hank needs to be on the mind of health leaders today and how are you guys tackling it.
Hank Schlissberg:
You know I’ll say scalability. Most of us in health care pretty much know the right answers for the system and for individual patients and we’ve seen them play out in amazing ways and in smaller pockets. I think the question is how those who financed the care in our country. So that’s largely the government, employers and commercial payers can drive solutions at scale. So CMS is recent overhaul and expansion of the ACA system through what they’re calling primary care is is a is a terrific example. A great example for DaVita Health Solutions is at the core of our care model which you mentioned which is house calls. House calls are a highly logical approach to care for the highest risk most chronically ill. It has to be happening for hundreds of years. It’s really hard logistically and the investment required to pull off high risk poly chronic patient care through a model like house calls it’s really tremendous to do that at scale and so it doesn’t make sense to keep with our sort of scalability theme for every individual hospital or every individual practice and a market to each build these capabilities and make these investments one off the infrastructure should be built one time through those financing the care by one provider for for everyone’s use in a given market.
Saul Marquez:
Yeah. You know it’s definitely at the forefront of a lot of the challenges that the providers are faced with and payers so it’s interesting that you guys have developed the model to address this really big pain point. And so I’d love to hear from you what the organization has done to create results and doing it differently.
Hank Schlissberg:
Let me pick one specific example and see if it resonates. We’ve been spending a lot of time lately thinking about patient engagement. It doesn’t matter if you have the right clinical pathways, the right data, the right model of care. If you take it the patient to actually engage with you or engage in their own health it won’t have impact. And so one of the things we’re doing to be to help solutions is we’re bringing talent in thinking from outside of healthcare on how you build trust with consumers what is the best thinking from the field of behavioral economics and data science to fundamentally rethink patient engagement because we have to move from a world where good is 40% engagement in some disease management program to a world where 80 or 90 percent of the patients that we’re accountable for are actively engaged with us and taking a hand in their health. And the reason this is so important this is sort of what you said in your intro is because when we touch a patient we reduce their hospitalizations by 40 percent and more than 90 percent of them tell us they had a great experience. So we feel an obligation to give that gift to as many patients as possible in the contrast, I often use you know with my team and others when we think about a comparison around trust and engagement and being in the home is airbnb. So here’s a business where where I can sleep in someone else’s bed I can shower in their shower and somehow both sides have convinced themselves that’s completely normal, right. And so I think we’ve got to get to that point in health care where we can break down some of those barriers the way people in other industries have.
Saul Marquez:
That’s that’s a really great call out. And so you mention Hank the house call and you know you envision the white coat with the black bag and you know the old school way of doing things. How much technology are you guys using along with the house calls.
Hank Schlissberg:
Yeah there’s…
Saul Marquez:
I’m thinking like a remote monitoring you know.
Hank Schlissberg:
Yeah yeah. There’s a huge amount so remote monitoring and telemedicine are certainly important parts of the care model. I would say probably one of the most advanced ways that we’re using technology is in the field of data science predictive analytics and artificial intelligence. So this is a huge part of what we’re doing and probably one of the most important learnings that we’ve had so far which is how do we use A.I. to make sure we’re identifying the right patients. So as I said patient engagement is a huge challenge for us and for all in this industry and one of the reasons the challenge is sometimes you can actually find false positives in the data. You can call these patients up and and offer them what seems like a really exciting value proposition right. I’d like to come into your home and provide you free healthcare right. That sounds like a great opportunity. And oftentimes they say you know I feel great right now or I’m at work or I’m at tennis right now. So we now have such advanced predictive algorithms that we can accurately predict not just hospitalizations or readmissions like a lot of people do but we can actually predict future disease related cause. So it’s a lot more helpful to know that a diabetic will have diabetes related cause or kidney related cause or heart failure related costs because now we know who and how and when to intervene. And so when we run this type algorithm against large datasets like the Medicare data we find that sort of traditional ways of identifying patients through chronic conditions can oftentimes identify as much as two thirds of false positives – mean patients who probably were going to become less acute on their own and at the same time miss as many as two thirds of the patients that we might otherwise have selected and been able to give our gift to.
Saul Marquez:
So moral of the story a combo of both is the best.
Hank Schlissberg:
Yeah for sure. No question.
Hank Schlissberg:
Gotcha. And so so how about on the. And you know you guys haven’t always had a system that’s produced results the way you’re producing results now but these are the most chronic patients. Tell us about a time when you had a setback and what you learned from that.
Hank Schlissberg:
Yeah well we’re all entrepreneurs so they’re nearly daily right. I think a good one I was thinking about is actually in my previous company before DaVita which was about a 40 million dollar venture backed company who was trying to disrupt and innovate around the clinical and business model for radiology. And this is about five or six years ago. And to this day I think we had a great concept and almost everyone I speak to about it still says how how did that not work? But it didn’t it didn’t. And I think…
Saul Marquez:
What was the concept in a nutshell?
Hank Schlissberg:
The concept was to aggregate radiology volume so radiology exams and studies and radiologists and optimize so that every single read could be done by a sub specialist who had proven that they were world class at reading that type of study. So we know for a fact that if you need an MRI of the brain on a nine year old you want a pediatric neuro radiologist reading that study. And that doesn’t always happen when you have a six person radiology group. And so we were trying to aggregate this and I think what we learned was that we were a little bit too early with the the evolution, the value based care hadn’t fully come to fruition, the inertia of local health care was challenging and so you asked what were the learnings. I think learnings for entrepreneurs were sometimes you are just too early and calling it early versus late is a skill unto itself and then and then also sort of while we saw the long term vision correctly we probably could have done more to find other ways to add value to our clients in the meantime create revenue and learn aggregate data, things like that and it was important learning.
Saul Marquez:
Now that that’s really interesting and so as the listeners are thinking of themselves wow you know fascinating topic. Your provider listening to this thinking to yourself maybe I could work with Hank and his team to take care of that population for me. And maybe you’re thinking well I’m already contracted and I already have something in place within you know I have an ACL or I’m working with my payor to do something like this what would you say to them, Hank?
Hank Schlissberg:
I would go back to this point about scalability which is every individual ACO will have high risk patients, every individual practice, every individual health system will have high risk patients. If you think about the investment that we’ve put in to building these capabilities a customized EMR that’s at the intersection of ambulatory and home health. The predictive analytics that we talked about, the scale and density in a market just to optimize routing and logistics and the software to do that the care pathways for such complex conditions. And I could go on and on and on about the investments that we’ve made. It’s nonsensical to us every individual practice in a market or hospital in a market would build those capabilities and so what we would say is and it doesn’t have to be us but find folks who can build these capabilities and scale them across an entire market an entire geography. And let’s take care of the patients, the highest risk patients in that market at scale and do it one time because we know right by definition if everybody is building it differently by definition it’s not optimized.
Saul Marquez:
Right, that’s a great message. It’s really just the message here is find a partner because we we really can’t be specialists at everything and healthcare is really super complicated. Hank’s message is find a partner that could do it well didn’t have to be DaVita, just find a partner to focus in on this particular subset of patients. And so on that topic, Hank, I love to hear from you what one of your proudest leadership experiences has been.
Hank Schlissberg:
Yeah well like I said for me now as my career has evolved it has sort of all come down to the patient. And so I can clearly remember my first house call right along like it was yesterday. The patient was Miss Harriet. We were in her bedroom and our nurse practitioner was getting to know her while our social worker was spending time with her daughter in law and on the one hand that was very proud prideful of seeing our work unfold real time on the other I felt pretty helpless just as I was sort of the business guy in the room right. And I’ll never forget that I saw an alarm clock in Miss Harriet’s bedroom that was flashing like when the power is gone out it just needs to be reset and I just kind of walked over and reset it and miss Harriet’s doctor conversation with our nurse practitioner and she said that thing it’s been flashing for weeks and that might be the most impactful thing that would happen to her all day right.
Saul Marquez:
That’s too funny.
Hank Schlissberg:
So this blinking alarm clock was really bothering her. Keep in mind this is a patient who had three strokes in the last six weeks who still wasn’t on a cholesterol medication was it in the right protocol and it could’ve been anybody. But I made a difference just by fixing her alarm clock. And that’s when I knew that our model of being in the home with our patients where they are in their lives and every day it’s happening them was gonna work.
Saul Marquez:
Wow that’s a neat story Hank and I could just picture everybody in the room and the lady just kind of have a sigh of relief from the alarm clock. And then your care team just delivering the solutions that she needed. That’s key. Yeah I remember having a conversation with somebody at TEDMED and they did some study she was telling me about she was an academician and she worked on some study with CMS and they found that having nurses show up in the home they discovered things that really didn’t cost much but like a crease in the rug that would have been a falling hazard or a flashing clock. Right. That that was just annoying them. It’s just incredible what being present does.
Hank Schlissberg:
Yeah. Yeah it really is and so we talk a lot about this concept of social determinants of health and all these things that you’re talking about whether it’s fall risks or food insecurity or transportation or loneliness or things like that. They’re often as impactful not only to the patient in their experience but even to the overall cost of care that will ultimately result as anything that will do clinically.
Saul Marquez:
So Hank you and I had a discussion before the podcast. Then I told you hey you know one of my misconceptions was hey DaVita, kidney dialysis. Right. I mean it was just for me an eye opener to learn about the great things that DaVita Health Solutions is doing. What myths would you like to dispel for the listeners today?
Hank Schlissberg:
Well DaVita’s ultimate objective is to make a difference in the lives of all the patients that we serve. So for sure dialysis is a huge part of what we do and we’re one of the world’s leading players in that. We also spend a tremendous amount of time thinking about other parts of kidney failure in addition to things that we do in DaVita Health Solutions. So an example would be we’re spending a lot of time thinking about getting upstream to patients with chronic kidney disease before they get to ever get to dialysis and hopefully delay the progression to dialysis if not even avoid it. And then if they do have to move on dialysis making sure that they’re fully educated about all the different mortality options all the different options for whether they want to treat at home or in a center or what their options might be for transplant as well. So I think we’re thinking about ourselves much more as a chronic condition management company and a broader renal focused company than just someone who operates in center dialysis.
Saul Marquez:
Brilliant. So out of all the projects that you guys are working on Hank what would you say is the most exciting today?
Hank Schlissberg:
Well it’s funny in our conversation we’ve actually hit many of them were so we’re spending a ton of time thinking about social determinants of health and behavioral health and other ways to impact the patient. We’re also spending a ton of time thinking about as we talk predictive analytics and A.I. and so you know I think just to reinforce that the idea of being able to identify the patients who are at one most in need of our care and two who are most likely to engage with us in a model such as this so we can have impact is probably the most insightful and new and revolutionary thing that we’re doing. I think what we find is most health plans don’t even always have a perfect view of who will be their sort of most acute, most chronically ill patients over the next few years. And so using some of the data science that we’ve put together will develop a pretty good perspective on that which then allows us to target our bench.
Saul Marquez:
You know Hank, it’s really interesting and I find it fascinating how the company is evolving to incorporate some of these newer technologies to help patients at the core of your mission. And I’m reminded of Jim Collin’s book I forget what the name on it, Last Thing?
Hank Schlissberg:
Built to Last.
Saul Marquez:
Built to Last. Yeah. Built to Last. Have you read it?
Hank Schlissberg:
Sure have.
Saul Marquez:
Yeah. And so you know when I read that book I had an epiphany it was it was I realized that a company is not defined by a product. I always thought, you got a product you got a company but in reality it’s the mission. And I love just seeing you apply some of those principles to DaVita and seeing that company transform. So I want to definitely give you guys a lot of kudos for the way you guys are changing with the times.
Hank Schlissberg:
Yeah thanks, Saul.
Saul Marquez:
So getting here to the lightning round Hank, we’ve got a couple of questions followed by a book that you recommend the listeners. You ready?
Hank Schlissberg:
Yeah. The Lightning Round. Let’s do it.
Saul Marquez:
All right. What’s the best way to improve health care outcomes?
Hank Schlissberg:
Well let’s stay with our theme of creating tailored care models and then the supporting payment models for specific populations around natural owners.
Saul Marquez:
What’s the biggest mistake or pitfall to avoid?
Hank Schlissberg:
Not regularly taking a hard look at the business model associated with your care model and insuring that it’s both relevant and timely and being willing to change willing to pivot willing to evolve. If it’s not.
Saul Marquez:
How do you stay relevant as an organization despite constant change?
Hank Schlissberg:
Constant change in and of itself is the answer. You were just talking about it. We strongly believe in DaVita’s core value of continuous improvement and DaVita Health Solutions we have a guiding principle of embracing the adventure. And I think those things sort of allow us to continue to evolve as the environment around us does.
Saul Marquez:
What’s an area of focus that drives everything at DaVita?
Hank Schlissberg:
Well we talk about something called the DaVita way and the DaVita way talks about caring for each other with the same intensity that we care for our patients. And we think that if we can do that it’ll shape many of the actions that we take with our patients.
Saul Marquez:
I love that. And these next to Hank are more on a personal note. The first one is what is your number one health habit?
Hank Schlissberg:
My number one health habit is riding my bike.
I love it. Do you do long distance or…
Hank Schlissberg:
I’m afraid of road biking and mountain biking. So we have trails we have great trails here in Colorado and Denver. So I was out there this morning on the trail and try to get better.
Saul Marquez:
Man you have good reason to be afraid it’s definitely dangerous. I’ve had a lot of friends get get real hurt with that with both actually.
Hank Schlissberg:
Yeah. Yeah. I stay off the road.
Saul Marquez:
Yeah. Yeah. And the second line here Hank is. What is your number one success habit?
Hank Schlissberg:
My number one success habit is being open to feedback. We try and create a culture of being very open to these kinds of conversations and hearing from the team whether that’s formal surveys after meetings whether it’s one on ones where we ask for reciprocal feedback as much as possible. I think we all have tremendous room for growth and we’re often blind to what those areas are.
Saul Marquez:
I love that, great tip. What book would you recommend to the listeners, Hank.
Hank Schlissberg:
Well as you gathered I’m kind of a sucker for entrepreneurship and innovation. So I’ll recommend two from the Mt. Rushmore of entrepreneurship and innovation. Jeff Bezos The Everything Store and Walter Isaacson’s biography of Steve Jobs.
Saul Marquez:
The everything store. I haven’t, I haven’t picked that one up. Well what is it.
Hank Schlissberg:
Yeah yeah. It’s basically the story of Amazon from start to finish.
Saul Marquez:
I love it. Definitely gonna pick that one out. Hank appreciate the recommendations folks, go to outcomesrocket.health and in the search bar type in DaVita or type in Hank and you’re going to find all of the show notes for today’s discussion as well as a full transcript and links to the work that Hank and his team are up to. This has been a ton of fun, Hank. I’d love if you could just leave us with a closing thought and then the best place where the listeners could continue the discussion with you and your team.
Hank Schlissberg:
Yeah. The easiest way to find me is just hank@davita.com. So that’s very simple in my closing thought is just on this idea of innovation, entrepreneurship and continuous improvement. I think none of us would claim that we’ve got the US healthcare system figured out for the patients, the providers or the payers and so just being open to new models of care, new business models and new approaches I think just benefits all of us and our and our children’s generations.
Saul Marquez:
Hank really appreciate your thoughts. And again just want to thank you for spending time with us.
Hank Schlissberg:
Yeah thanks Saul. It was a blast.
Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show notes, resources, inspiration and so much more.
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