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Jim Jordan:
Welcome to the Chalk Talk Jim Podcast, where we explore insights into healthcare that help uncover new opportunities for growth and success. I’m your host, Jim Jordan.

Jim Jordan:
I’m thrilled today to welcome Jeffrey Lewis to our podcast. Jeffrey is a distinguished executive and a leader with a really rich background in both public and the nonprofit sectors. The world has created Jeffrey has been at the forefront of innovative projects spanning from healthcare, pharmaceutical policy, pension reform, and women’s advocacy. With this deep-seated experience in driving organizational transformation, Jeffrey underscores the significance of expert advice and data-driven solutions in today’s conversation. He provides a valuable insight into how philanthropic capital can be leveraged to kick-start new programs and shape policymaking, particularly in healthcare. Our discussion today navigates through intriguing topics such as pharmacy benefits management, effective handling of pharmaceutical data, and often neglected needs of caregivers, and the promising role of artificial intelligence in population health management. Jeffrey, welcome, and tell us a little bit about yourself.

Jeffrey Lewis:
I’m the president, CEO of two healthcare foundations in the California Central Valley, which is two rural counties in the Central Valley. We use charitable dollars like a venture capital fund, building healthcare solutions and funding healthcare solutions in the southern part of one county and the northern part of another.

Jim Jordan:
I believe we went back in 2011 when you gave a talk at Heinz College at Carnegie Mellon University.

Jeffrey Lewis:
Yes, 2011, I could have given a speech there on my way out the door and going from president of the Heinz Family Philanthropies, back to the corporate world.

Jim Jordan:
You’ve always focused on developing solutions by listening to people actually doing the work rather than relying solely on the government.

Jeffrey Lewis:
So I’ve long believed that while government or congress can be helpful on health policy, that the real policy decisions and the creation of policy is most effective when you talk to people who are actually doing the work. So when I worked in Congress for a number of years and was a staff director, when there would be a recess, we would go out into travel across America talking to healthcare experts or whatever the topic was about what we’re thinking about legislatively and to get their opinions about, will it work? What are the obstacles? What do you think? What will work better? So never afraid to ask the tough questions about what we’re doing to make sure that at the end of the day, if the senator was going to introduce new legislation or modify existing law, that we can come back and say, we got the best advice from your constituents as well as constituents across the country on this specific topic, health policy, as you watch Congress evolve, which is kind of sad these days because health policy is not something that they focus on, although I guess they passed a new PBM bill yesterday, but there’s still a lack of understanding of the value that a PBM brings because there’s always value in terms of what they’ve been able to do and there’s always problems. But my approach to this, particularly from the philanthropy side, is how do you use charitable dollars to enhance the lives of individuals regardless of their income? So don’t just focus on a Medicaid population, but don’t forget about a middle-income population. And how do you use those dollars to build solutions that before government spends money, that you could be the petri dish in terms of the pilot project? And you can use those dollars and take them the data and have the data explain to them, here’s what this really means. Here’s what it really cost to care for James, who’s 73 years old. He’s got three comorbidities and limitations on activities of daily living. So here’s what it cost to take care of him in his home every day, or James and his wife have a ten-year-old who’s got intellectual disabilities, and the child qualifies for Medicaid, but Jim and his wife don’t because they both have jobs, or he has a job with commercial insurance. But Jim and his wife can never escape, and I use that word specifically, for arrest, for a romantic liaison, for a mental health day, because if the state provides respite care, it’s sporadic. It’s increasingly more difficult today because you can’t find the respite care working for the state programs, but no one’s really focused on Jim and his wife. So we focus on the kinds of issues that people don’t typically talk about to build those kinds of solutions because I refuse to forget about the middle income. You know, it’s very much my line is the forgotten middle class because that’s what government does, whether it’s state government or the feds in terms of it’s great to do all this stuff on the Medicaid side, but what about middle-income people with an increasing number who have high deductible health plans? So every January that kicks back, that deductible might be higher because they can get a lower premium that way, but it’s still cash out of their pocket. So how do you design a solution to help them while not forgetting about them?

Jim Jordan:
It seems like you’ve always focused on developing solutions by listening directly to the people doing the work. How does that philosophy apply when looking at the broader healthcare system?

Jeffrey Lewis:
It is, and it is at the core of how an employer survives when the market is changing. And when you have both domestic and international competition on a product, your margins are shrinking, not growing, and healthcare costs become a very important part of that conversation. So let me go back to your basic question. Healthcare is both a right and a privilege, it’s not one or the other. Every American should have access to healthcare services, plain and simple. And there’s an infrastructure in place to help them, but is it the best infrastructure is a bigger question, and we have to recognize that. Let me go back to high deductible health plans that you were using yourselves, you, and your wife, as an example. You’re going to choose something that’s affordable, but what’s the impact on you in the future if, God forbid, something happens, and you’re going to have to put out $30,000 or $40,000 or more out of pocket, or more importantly, if you need a specialty medication and you’re still putting, let’s say, a $2,500 initial deductible before the drug pharmacy program kicks in, but let’s say it’s a tier 4 drug, and it’s especially bad, and under your program or under your Obamacare plan, you’re paying the highest rate out of pocket, and you’ve lined up and signed up for the pharma-based program that are great programs no matter what people say. And I’m not going to bash Pharma because I think that what pharmaceutical companies do in America to help people with chronic disease conditions and costs often is overlooked by Congress, by state legislators, etc. Not that they’re perfect by any means, but what do you think about the implication of healthcare as a right or a privilege? It then comes down to, how does my state legislature look at this? How does my city council look at this? Are there programs that they could build that will help us as taxpayers in our specific state that don’t just inure to one specific population? And that’s often the part that’s missing. It’s the blend of health policy and health reality. And, you know, I’m an old guy, older guy, so I look at this through a very different kind of lens and try to say, let’s look at the data, because the data is really what tells a story. So think of it, you know, James owns a corporation, and he’s just sold it, and a VC company is thinking of buying it. And the VC company says, okay, we have 100 employees or a thousand employees. Often, they don’t look at the health plan, and they have to look at the health plan. They have to look at the health data because the health data will tell them, okay, buy James’s company. They’ve got 1000 employees, which means about 3000 lives, if you figure between family members. The data will tell them without going specific to an individual, the pharmacy data will tell them all about the members in the plan, who’s precancerous or on cancer drugs, who’s got a potential kidney, dialysis, those kinds of things. The same thing that government needs to do when it looks at its employees and family members or Medicaid population to really understand what are the implications of the decisions that we’re making today on a family regardless of income tomorrow, and that right to get access to healthcare as well as a privilege to depending on what state you’re in. If you’re in Massachusetts, you’ve got greater opportunity than if you’re in Arkansas, you know, have the same kinds of constraints that the legislature is pursuing. But years ago in Massachusetts, which I was very familiar with, where I spent a lot of time, there was this theory that if we could aggregate the prescription drug programs together, the state could save a lot of money. And my response to the proponent of that was, yeah, if you’re the purchaser. So we did this analysis for Governor Cellucci and delivered it the day of 9/11, and I flew in that morning. You never, you don’t forget that. But the analysis showed, okay, if you aggregate state programs together, think of it this way. You’ve got, let’s say, eight programs in the state of the Commonwealth of Massachusetts. You’ve got prisons, public health, Medicaid, public employees, public retirement employees, HIV Aids programs, etc. If all these programs, typically in a state, it’s not unusual in state government, whereas each state agency negotiates its own contract. And even if you’re using the same vendor like a pharmacy, PBM, or a wholesaler, often the contract says you can’t talk to another state agency about what we’ve negotiated. So in the procurement world, which affects all this, there’s a lack of understanding because state legislators don’t get underneath this and ask the right kinds of questions. So our analysis showed that if you aggregate state agency purchasing together and you go to a single contract through a single PBM, a single wholesaler, a single GPO, you could aggregate the lives together and your purchasing power, and you’re going to save a lot more money. PBMs don’t like that because they like to negotiate agency by agency so they can figure out what they did make from Mike, they’re going to make from Craig. Wholesalers, here’s a real-life example. We did the same analysis for, in Florida, and my client in that case was the Senate president, and the chairman of the Senate Budget Committee on the Budget Committee were members of both sides of the aisle who were really interested in what we were doing because we were not only mining data, we were telling them what their contract said. So we’re doing their procurement work after the fact. And the reality is this. So here you have a group purchasing organization that has a contract with the wholesaler, and the contract says that there’s only so much that the wholesaler can do without first getting the permission of the GPO. So in this particular case, I can’t offer you my lowest source pricing on generics unless the GPO approves it. Well, in the procurement world, you can’t just hire a GPO or a wholesaler. You have to understand who they are, and then you have to demand, know what the contract says between them, because that’s where you lose money or that’s where it costs you more money. We presented the data and the analysis to the Senate Budget Committee, and the politics of the situation were that I think people were some circumspect of what we did, but by the end of the presentation, you know, I had a committee on, roaring in delight with what we said because we explained their own data to them, something that their procurement people couldn’t do and something that their vendors weren’t doing, and their vendors weren’t sharing the data and it’s their data. So it’s an interesting situation as you go back to your question on right and privilege, it starts at the top in a state, from a governor’s office down to the individuals getting the service. Every step of the way, it impacts the lives of a taxpayer that they don’t know about, and if it’s not done correctly, it adversely impacts them as well as the rest of the community. So those are the challenges.

Jim Jordan:
Are GPOs and other legacy structures still providing value, or have they become obsolete?

Jeffrey Lewis:
For sure, you have to look at which GPO you’re talking about because often, there’s very different GPOs. Second, in an integrated health network, so let’s use Massachusetts as an example where you’ve got Harvard, Pilgrim, multiple networks across, you know, at different aspects of the state. They’re sophisticated enough where, you know, when they’re drilling down on buying, whether it’s negotiating on the pharmacy side or on the equipment side, that they’re going to leverage their aggregate purchasing as well as or better than most as compared to, you know, a comparable system in another state, regardless of what state it might be. It depends on the leadership and the sophistication of the people working for the entity to know how to negotiate and talk with GPOs, or PBMs, or wholesalers, or manufacturers. And if you don’t have that, and if you haven’t done a spot check, which means you bring in consultants to verify that you’re getting the best value, if you don’t ask the tough questions, you never get the best answers. And the public sector and the private sector often fail at that.

Jim Jordan:
So moving through your career, you’ve gone from government, and then you start getting into the philanthropy side of business. How did that transition happen? How did you move in that direction?

Jeffrey Lewis:
So I was the Republican staff director for the late Senator John Heinz in the Senate. He was killed on April 4th in 91, in an airplane accident. And I’d met Mrs. Heinz maybe 2 or 3 times, and I had the opportunity to go to work with her to begin a sort of one capacity, which then evolved into both her chief of staff and also running her family philanthropy. They gave her a segue from her late husband to going forward. She had an interest in all the kinds of legislative activities he was doing in domestic policy. So it just happened, and I did that for about 20 years, and then three Senate campaigns for her then-husband, John Kerry, a presidential campaign. And as a token Republican, it’s always a challenge. It was a phenomenal experience. And we got to use philanthropic dollars the way I’ve described you, how I’ve always done it by leveraging those dollars to use as venture funds to really look at how you can invest charitable dollars to impact change or/and analyze what we were doing. So in our case, we were consultants for multiple state, multiple governors, and healthcare issues we tackled in Massachusetts, where they had a prescription drug program and we collaborated with the speaker of the House and Senate president and said, you’re spending, let’s say $50 million in this program, we can design it so you can get a better value for the public dollar being spent, and we had both legislative support from both sides of the aisle. We had some legislators who didn’t like the approach we were taking because it would be income-based. And at that time in Massachusetts, the idea of means testing was something Democrats hated. Can’t speak for how they feel about it today, but we did focus groups, and we did go out and do focus groups, and we asked the questions of Massachusetts residents, people over 60. Here’s how this program would work. What do you think about this? And when you ask the question, do you think you should pay as much under this program as a multi-millionaire, the answer was no absolutely every time. And so what do you think about there’s a concept called means testing is income-based. So if your income is between X and Y, you’d pay this much and between Y and the next one this much, but at the top of the triangle would be the person whose income was at $100,000 or more, they would pay the max. Is that fair? Absolutely, that’s fair. We shouldn’t pay as much as a person who’s retirement income is $100,000 a year to validate our recommendations to the legislature. And ultimately, they modified it, and it got passed in some modified form. And I sort of lost track on what happened with the prescription pilot in Massachusetts. When you do this stuff, you have to be willing to ask not just tough questions, but listen, and my experience is that a lot of people have a difficult time listening. I might not agree with you, but I have a responsibility to listen to you and to understand why you’re saying what your perspective is and why. So if I’m constructing a solution or a product, I got the best advice possible, even the advice they may not agree with. So as you’re working in philanthropy, you have that unique opportunity to really be a great listener. And it was invaluable because we spent time talking to women across Massachusetts about issues that they cared about that impacted their families but also impacted them. Never forgot the conversation with … So we launched a project in 1995, in Mass, in Boston, to do a women’s health and environment conference. What’s the nexus between women’s health and the environment, which there are many issues, and it was free use charitable dollars to put it on, bring the people together, feed them at the same time, bring these really brilliant people together to help them understand and ask questions, as many questions you want to ask. 800 people showed up the first year, there was like 1500 people every year thereafter, and it was a great way for them to meet Teresa Hines. But more importantly, her interest was to really give people the opportunity to listen, to ask questions, and to begin to understand the nexus between these issues. They were not easy issues in some cases to understand, but a great way to use philanthropic dollars to help people understand the challenges that they face and that, what the answers would be in doing that. It’s the same thing, and I’ll tell you, we did, we were working with Congress, I think it’s 1995, and at that time, a woman who worked full-time at home could only put $2,000 into an individual retirement account. She was liberty, however she did that. But a woman in the workplace could put in, as you know, as much as she wanted to. And it made no sense economically, it made no sense in terms of preparing for the future. So we did a legislative hearing in Boston, Massachusetts, and brought in at that time Senator Carol Moseley Braun, the first African-American senator and the female senator of the United States. She served on the Senate Finance Committee as well, where I had worked. And we talked through state legislators about this and great conversation. And ultimately, she went back, and we changed the law to thank the 95 or 96 tax bill so that that wasn’t a prohibition to women who worked at home, who could really shelter way more money because focusing on your retirement was something that we, Senator Heinz, is very invested in. And it was a great interest at the time of Mrs. Heinz as well. So it sounds like my job.

Jim Jordan:
Let’s shift to discussing the philanthropy side. How did you transition into that area after working in government?

Jeffrey Lewis:
So the philanthropy in the two foundations that I run in rural California were created when the local hospital was a non-profit sold to a for-profit. So the deputy Attorney General over the sale decided that the footprint of the old hospital is another profit were these 19 zip codes. I actually believe there were more than that, but that’s what I got to work with. So I’m the first president and CEO of both foundations limited to these 19 zip codes. So we use those charitable dollars to support nonprofit healthcare providers that include federally qualified health centers, non-profit home health programs, palliative care, hospice care, etc., but we also use them to create our we build our own solutions because, you know, you have a growing forgotten middle, as I referred to earlier, in terms of middle-income population. You have as more women age in place, a feminization of poverty in old age because of circumstances that they did or didn’t control, and you’ve got families with kids with intellectual disabilities who can’t access services or can’t escape. The romance has gone to, one of them’s exhausted all day for dealing with the child. And you can use these charitable dollars to help people survive. So we’ve built solutions, for example, I’ve always been concerned about the cost of prescription drugs. So there’s a local pharmacy. We have multiple pharmacies here, but I focused on independent pharmacies because they’re the lifeblood of small business. So we found a local pharmacy run by a couple of really brilliant women. I took to them the idea, I said years ago in a project for Cory Booker when he was mayor of Newark, New Jersey, and we built a $2 drug program in Newark for anybody who went to these two different pharmacies, and they could fill their prescription drugs based on the formulary, let’s say, 250 different medications. Well, my objective was to say, that’s great. So in Turlock, we’ve built a solution for more than 700 different generic drugs that anybody with commercial insurance or uninsured can go fill their prescription at this one pharmacy for $2. 30-day supply, 90-day supply, whatever makes the most sense. And then you quickly realize that with the cost of insulin in the insured market and with more and more people at high deductible health plans, people are struggling to pay for their insulin. They’re doing everything you hear about in spades in the news. So with the same pharmacy partners, a company called TNRx, we built a $2 insulin program to say to anybody with commercial insurance or uninsured that you can fill your prescription for your insulin at dinner for $2, and we use philanthropy dollars to make up the difference in co-pay. All right, so James goes in there, and he’s got a $40 or $150 co-pay on his monthly insulin costs. He’s going to pay two bucks, and we’re going to pay $148. My objective and the foundation’s objective is to help you leverage your dollars as effectively as possible, understand the impact it has on your life. Tell me how you’re spending the savings. What are you doing with the savings that we’re helping you achieve so we can better understand what the market really means? It conceptually, it sounds fabulous. And with a program that’s working well, and as I say, my partners at TNRx are two of the finest, brilliant women I’ve met in America. In pharmacy. The downside is getting people to change pharmacies. I’ve been going to Rite Aid and seeing Fred, the pharmacist, but you’re paying $100 a month. You can enroll in our program. What’s required? Name, address. Do you have insurance or not? And proof that you live in this one zip code. You know, these 19 zip codes, that’s all it’s required, no income requirements. You could be making $250,000 a year or $15,000 a year, we don’t ask because it’s equitable, and the objective is to help you help yourself. But getting people to move from an established relationship with a pharmacist where they’re still paying more than they should pay is challenging. Now we’re going to expand the program to another pharmacy in a neighboring rural county. It’s even more rural, and we know that in the first three months of the year, starting in January, with the high deductible health plans kick back in, the pharmacy will have a line out the door in terms of people filling their prescriptions. But the irony here is in, these guys own a pharmacy in two different towns that are five miles apart. So it’s not a long distance, but the best story is they go to this one pharmacy, and the pharmacist says, well, James, I can fill your drugs, you’re going to be a couple of days here because we have to order it, but our other office five miles away has it. You can just go there, and I can just transfer the prescription. But the person says, no, I don’t want to drive five miles, ten minutes. I’ll wait till the two days for you to get it here, and I’ll just come here, and you kind of scratch your head and say, you’ve got a car, and you’ve got transportation. It’s five miles away. You can start on your antibiotic today, now, but you choose not to. So it’s interesting why people do that and wish I could give you an answer, but they are reluctant to drive, they’re reluctant to change pharmacies. You create solutions that you hope will really help a lot of people. Our 19 zip codes are an international melting pot. Iranian, Iraqi, Afghan, Ukrainian, Portuguese, Swedish, Hmong, Punjabi, Sikh populations all living here, you know, began as a really small Swedish-Portuguese population is now an international footprint. So you advertise in multiple languages to get people to do these things. And it’s a challenge getting people to change behavior even if it will save them $10 or $15 a prescription. So we continue to talk with them about this, and talking with them, you learn some things. You, we can have you transfer your prescription, we’ll have it delivered to your home. Okay, well, that helps. It takes a little barrier away. I don’t have to leave the house, it’ll get delivered. I’ll mail it to you. We’ll pay for the extra mailing cost, we’ll do that. But it’s not always easy when government says, you know, here’s my solution. It’s not always easy to help an individual who doesn’t want to be helped. So our database is phenomenal, but we’ve implemented a long-term care program. So let me go back to your Pittsburgh experience in Southside Pittsburgh. Great area, great restaurants. I miss them dearly. So when Senator Hines was alive, we were doing, and long before Senator Hines and the other senator I worked for in Congress, Senator Bob Packwood, we created legislatively what we call Title 21 and the Social Security Act, where you would merge all the long term care services under Medicare, Medicaid, and other federal programs into one title under the Social Security Act. And it was a Packwood, Packwood, Bradley, Bill Bradley from Illinois, … for New Jersey project. And we got great press and, you know, sounded good, and but didn’t quite get there. I never forgot the legislation that I wrote in 1981. So now it’s 2022. We launched a project in Turlock, California, where for people over 50 and our 19 zip codes with multiple chronic disease conditions with limitations on activities of daily living are struggling for those kinds of services. We launched a program with a for-profit partner as well as nonprofit partners to provide these services at no cost, no income requirement, so there’s no income test, just to say what does it cost to take care of Jay Holmes, who’s a 55-year-old male, who’s disabled, who’s got multiple chronic conditions, etc., and at the same time build a database so I can go back to state legislators and others to say, when you think about long term care or community-based services for a non-medicaid population, although we’re getting a lot of Medicaid patients, here’s what it really costs. And why are the Medicaid managed care providers providing these services? That’s a really interesting question that we’re diving into. But the other aspect of this that people often don’t think about is, from our perspective is, if James has a wife and you’re living at a retired income, so you’re in think of this, you’re in one household, and you have two people, and you’re sick, and she’s the caregiver, no one thinks about what are the caregivers’ needs, what are her behavioral health needs, what are her emotional needs, what are her primary care needs? What are her caregiver needs? Can she escape from James for 3 or 4 hours a day or not? And you quickly learn that the caregiver is one of the most important parts of solving the problem because you have to take care of her or him as well.

Jim Jordan:
You highlighted the overlooked needs of caregivers. You know, what implications does this have on the broader healthcare system?

Jeffrey Lewis:
The opportunities are without boundaries. You have to first, as AI is developing and it’s well developed in many respects, how you can use AI as a predictive tool in a federally qualified health center population. So lower-income people who are going there, and AI will help them because it’s already being tested now by some colleagues of mine. How can that help the FQHC ensure for greater quality of care in what the data is telling them through AI? And what will it predict in terms of the chronic disease conditions of that specific person based on the cocktail that they take for the disease that they may be dealing with? The second part is a recognition that there is a role for the federal government, and it’s an important role, but it should never be an intrusive role. So it’s one thing to conceptualize Obamacare, it’s another thing to implement it. And then, the states should have the flexibility to figure out state-by-state basis, how do we do these things that make the most sense to us? So what happens in Pennsylvania is not going to be the same that happens in Iowa, or what happens in Iowa is going to be different than it is in Wyoming. You need that flexibility. And when legislators and bureaucrats don’t give them that flexibility, it’s wrong. There’s just no other way around it. The third part is to recognize the value of commercial insurance and what commercial insurance can do to really help employers. And in that sense, when you talk about integrated health networks and help that employer understand what the value proposition is, if your employees use this network. But to go back to that employer with the data, because that data that employer and their HR team need, and the CFO more importantly, need to be educated about what the data says and how it’s used so they can see the impact of it. Fourth, I would say that the future, well, PBMs are being bashed left and right. There is a value proposition, the pharmacy benefit managers play. It’s managing data that they do for insurers, and it tells the insurers things that are part of predictive modeling in terms of, you know, your patient who’s taking this cocktail, this is what it means for the future, and it helps them drive services to make sure that you incentivize that patient. How do I get you as a diabetic to get on Manjaro or Ozempic? Because they’re going to help you with weight loss. I can extend your life, I’m going to reduce your weight and do certain things that are helpful. And if you don’t produce Abate, then your costs are going to go up, and your employer will be notified that, and that’s helpful to the employers. On the pharmaceutical side, we need to recognize that what every other country does in managing or capping pharmaceutical costs is the challenge for America. Do you want to kill capitalism? Because once you decide you’re going to put a cap on or dictate how pharmaceutical costs are done, you can’t stop there. You have to do it across every sector, and are you, as a legislature or a Congress, ready to do that? It’s one thing to talk about it. It’s easy to talk about. It’s a great campaign tool. But having the courage to stand behind it and understand the implications of it and not just wave a flag or pound your fist on the desk and say this is what we’re going to do, as opposed to saying, okay, you are producing life-saving drugs, Pfizer, Moderna, you produced COVID drugs that saved lives. Yes, we lost thousands, tens of thousands of lives, but your drugs saved America and saved the world, and let’s not forget that. But let’s also not forget about the price of Lilly, who is capped, the cost of insulin before anybody else, but no one gives them credit. But let’s also talk about the other insulin producers who are charging ridiculous prices but not following the Lilly model and capping the costs at certain expenses. That’s a distinct role for Congress to come back and say, well, you know, you didn’t have to develop the formula. It was done years ago, and the guys who developed this drug gave it to you, and now you’re making, you know, hundreds of millions of dollars, if not more, and impacting the lives of individuals who can’t afford their co-pays. And does that make sense?

Jim Jordan:
You discuss some of the controversies around drug pricing. What role do you see artificial intelligence and other technologies like this in addressing these healthcare challenges?

Jeffrey Lewis:
I don’t think we know. I think that they’re, listening to the people in the AI space is very important. Probably one of the smartest people in the healthcare space is a guy named Dr. Ashish Abraham, who’s a both entrepreneur and a researcher. They have developed an AI tool. They’re testing it in Hawaii and a few other states, and the Medicaid population with qualified health centers and others. I’ve hired them here and the 19 zip codes with one particular provider so we can figure out from a predictive modeling perspective. Can I help you really care for your patients better based on the interaction of the data with the AI says? I would be somewhat careful in terms of how it’s used because, you know, the story is about people asking a question. It’s writing a paper, which you find out, if you use any of the AI, some of the AI tools, you ask a question they give you four paragraphs, and then you ask your second question. Can you give me some newspapers where I can find these stories? And they give you sites, but when you click on the site, it doesn’t exist.

Jim Jordan:
With all the changes in healthcare, how do you stay on top of emerging issues and keep a pulse on what’s happening?

Jeffrey Lewis:
Well, it’s actually very easy, you know, when you read 5 or 6 newspapers a day, so you read The Wall Street Journal, you read The New York Times, you’ll read either an LA Times or a couple of California papers. I consistently try to do focus groups to keep in touch with what people are thinking. We spend time talking to bigger brains across the country, in the academic world about what do you think about this? Or, you know, and have a conversation, pay them for their time. You know, I still talk to people in Congress once in a while about certain things, and I have the advantage of helping local elected officials on enormous challenges like the homeless and trying to figure out what can you do and how do you do it, and how do you as a public, as a city, as a city government, how do you spend your dollars as effectively as possible? So in about 30 minutes, I’ll be having lunch with the city manager of a particular city. I’m going to show him a circle that has 20 different entities in it, and they’re all providing meal programs for that particular city. There’s no coordination, because I’m the guy that’s asking questions, well, there’s a better way to do this. So stay in touch with what the today is versus tomorrow is actually the most fun part, because I ask a lot of questions I had, and the Internet gives you access worldwide to look at some of this stuff, but the other way is just talking to people. Never forget to listen, and I spend a lot of time, admittedly, in a cigar bar, and I listened to more conversations, you know, what people are thinking because they’re there, they’re drinking, I’m drinking. I’m drinking club soda, they’re drinking whatever it is, I’m smoking a great cigar, and they’re talking, and they just want to talk, and you know can maneuver around that and ask some really interesting questions, but you keep a pulse on what people, working men and women, are thinking about, and that’s an invaluable tool. It’s his own focus group, and I’ve always found that to be just a unique opportunity. The other aspect is to really not be afraid to be wrong. Come up with an idea, run it by a couple of people that I respect. Nah, it’s not going to work, here’s why. And then you dive in further deep, dive in as deep as you want to go, and sometimes, they’re correct. It’s a bad idea, let’s go in a different direction. Sometimes they’re wrong, and you can go back and say, Well, here, let me show you why we’re going in this direction. Humility is probably the most important part besides listening is just being humble. And if you learn anything in life, and I live in these rural communities, I’m surrounded by you buy products in the grocery store, buy melons or fruits and vegetables. I go to different farmers’ market every day and get them off the farm, and you talk to the farmers, you know, what’s it cost to California Legislature passed some new law about pork has to be humanely raised. Well, the price of pork goes up by 2 or 3 bucks a pound, you tell that to a family who’s trying to feed itself. All those factors combined, you learn very quickly that you’ve got great ideas, but there are people with better ideas. So let’s have a conversation and talk to academics and professors like you who can say, I’ve talked to neurologists. That is so important to me because I’m in negotiations with one specific university to getting neurologists to come once every three weeks to one particular rural community where they won’t, some people don’t have access. So we’re figuring out ways to solve that problem, but at the same time, I want your stuff, or if I can get access to it, to say to the School of Neurology, because I can talk to the dean. Look, here’s some really interesting things. Are your students, are your … just aware of this? But the last part is this, it’s not just about the patient and the caregiver. It’s also about the economics impacting the caregiver. So much in typical …, typically going to be a woman caring for her aging husband. How much is she spending of her retirement income or their retirement nest egg today that will impact her life tomorrow? And if I live in one household with one retirement income and I have to put my husband in a long-term care facility, but I still have one income, but now I have two households, and I’m dividing that income until a point where, because if I didn’t get divorced and he doesn’t have his own money, we’re going to have to spend down, which adversely impacts me personally and in multiple ways. We don’t talk about that. So keeping current on these issues, I’m dealing with currency every day. The real challenge is figuring out what you can accomplish, and what you can realistically do, and who’s going to listen to your data or not. So that’s both the academic side, the programmatic side, the political side, and the humanities side. And my single focus every day is if I can change one life or make one life better, I’ve had a great day.

Jim Jordan:
I think that is a beautiful place to end. That is, as we say, creating health policy from the outside in, and I thank you so much for the generosity of your time and your commitment to this problem, a lifelong commitment, obviously, and how much you’ve helped society. Thank you so much.

Jeffrey Lewis:
My pleasure. Great to meet you.

Jim Jordan:
Thanks for tuning in to the Chalk Talk Jim Podcast. For resources, show notes, and ways to get in touch, visit us at ChalkTalkJim.com.

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