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Synthetic Biology: The Promise of DNA and RNA Code Editing
Episode 354

Mark Crockett, Chief Executive Officer at Verge Health

Synthetic Biology: The Promise of DNA and RNA Code Editing

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Synthetic Biology: The Promise of DNA and RNA Code Editing

Episode 354

Recommended Book:

All Creatures Great and Small by James Herriot

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Synthetic Biology: The Promise of DNA and RNA Code Editing with Mark Crockett, Chief Executive Officer at Verge Health | Convert audio-to-text with Sonix

Saul Marquez:
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Saul Marquez:
Welcome back to the podcast. Saul Marquez here, today I have the privilege of hosting Dr. Mark Crockett. He’s the Chief Executive Officer at Verge Health. Mark is an experienced CEO with a demonstrated history of working in the hospital and healthcare industry. He’s a skilled healthcare consultant, disease management executive development, Medicaid, and emergency medicine physician. He has strong business development professional skills with EDP program focused and business from the Wharton School University of Pennsylvania. He’s served in many different roles including Chief Medical Officer and Senior Vice President at Best Doctors Inc. CEO of Rise Health, CEO and President of ibex Healthdata, President of Emergency Care Division of Picis and Chief Medical Officer at OptumInsights Accountable Care Solutions. He’s definitely a regarded publish author and the Journal of American Medical Association and other journals and among all of the things that he does, he’s fully committed to his work at Verge Health today which is what we’re gonna be diving into. So Mark it’s a true privilege to have you on the podcast today.

Mark Crockett:
Thank you very much I appreciate that. It’s a pleasure to be here.

Saul Marquez:
Hey it’s a pleasure. And so curious, what got you into the healthcare sector to begin with?

Mark Crockett:
It was almost about a family obligation. My grandmother on my mother’s side practiced until she was eighty six years old as a family practice physician.

Saul Marquez:
Wow.

Mark Crockett:
Her husband was a surgeon who died while still practicing in his 70’s.

Saul Marquez:
Amazing.

Mark Crockett:
My mother and father are both clinical psychologists. My mother still sees patients. She won’t admit to being eighty seven years old. You know it’s one of those situations where I really can’t retire until my parents do.

Saul Marquez:
That is too funny. And I understand my friend. So you’re you’re here and so you started as an E.R. physician but then made your way into entrepreneurship. I’d love to hear that story. And then fast forward to what you believe a hot topic is today that health leaders should be focused on.

Mark Crockett:
Sure. Well so just by history a lot of my life has been about being very very fortunate to be in the right place at the right time. When I was in high school actually a young woman who worked at Discover Card in Lincolnshire Illinois gave me my first shot as a young intern at learning something really interesting around I.T. and I had a summer job working with computers and it was really very interesting. But again the family obligation was to go into medicine and I loved it absolutely loved it, loved medical school, loved residency, loved practicing emergency medicine, but when I got out of residency it’s a wonderful opportunity to manage an emergency department. But we really did have great tools so it was the problem at hand was managing an emergency department better and some really wonderful people. Dr. Landes at Christ hospital just a gallery of just fantastic physicians that I worked with over the years. We built one of the first electronic medical records for healthcare which was called the ibex was first EMR that was web based for hospitals and we built that business and put it together with a company called Picis by the way you’re one of the first people to pronounce that the right way. So but just absolutely wonderful experience growing that business over time. At one point we had almost 20% of the emergency departments in the country use one or another of our tools. Then we put that business together with Optum which was another wonderful group of people who is a technology and services business attached to United Health Care. So I was now working in population health at Optum. And I’ll tell you. You know there’s a a trend in healthcare of going towards value based contracting. One of the things that was always a problem I had with the practice of medicine back 15 years ago is that if you made an error you still got to bill the patient for all the results of that. So you know if I licked the knife and gave you an infection during the procedure I literally could charge you for the extra days in the hospital and the antibiotics I gave which you know physicians don’t act that way. They don’t… I don’t know any physician that would ever make an error in order to make care worse and therefore enrich themselves not one person I ever met in healthcare would do that. But at the same time you’re not going to spend money to innovate safety and quality when you’re directly not incentive to do so. So you know as I got out and got into Population Health at Optum and these value based care contracts were along I really felt like this was the best thing in healthcare. Was this change in the way we contract change in the way things are valued. So it’s been an entrepreneurial journey for sure in healthcare. But I’ll tell you what in the last couple of years working towards a new set of alignments and incentives has been one of my favorite. It’s been one of my favorite times in healthcare to one.

Saul Marquez:
Yeah it’s definitely an interesting time. And I think moving toward better. Give us an example of how you and your team Mark have created things and improved results by doing things differently.

Mark Crockett:
Sure. So you know obviously we see our role as helping our clients get results right. So you know I have to say it’s our clients that drive the outcomes but boy are they driving outcomes. So our organization for health works for about nine hundred organizations across healthcare mostly acute care hospitals or health systems. So organizations like Robert Wood Johnson Barnabas, Cleveland Clinic, Centura, Kaiser, Inner Health, just you know a wonderful group of people to work for and our tools are largely go into three categories. There’s accreditation and compliance. There is basically credentialing and provider services and that includes things like peer review et cetera. And then there’s patient safety which is a first offense and patient relations. All of those things have traditionally been viewed as silos in hospitals. And so as we brought all of those together into one software as a service platform and we started our clients started saying “hey you know as we start working with your tools we see just these tremendous opportunities to use the different tools to reinforce each other.” So I’ll give you an example I’ve got a large health care system on the east. They had been working an area of patient experience and of course the patient experience is defined by patient safety. If you take your five year old to the emergency department and the child you know the injury while they are… you just you never recover from that. So the number one patient experience item is patient safety. So already our patient safety and patient experience tools that are on the same platform we’re seen as being valuable by them. They hired a consultant who came and charge them a boatload of money to look at their patient experience processes across the enterprise and what they did was they said we think that you can be more efficient. We think you get better patient experience and we can roll this program out to all of the multitude of hospitals that you have. So they did this work. They rolled it out. They educated everybody, they changed their policies to support this and they said “We’re doing great.” But what they didn’t really see was and we can tell this because we see in our patient experience software we can see the event they didn’t really move the needle on the actual patient experience with this effort. So by using our accreditation and compliance and rounding tools we literally can send somebody out with an iPhone to ask a set of questions of people and say “hey are you using this? Are you experiencing problems using this?” We’ve got this new process. How well is it being implemented? Are you finding challenges to implementation or is everybody educated to that? This is a compliance technique that comes from outside the industry. This concept of random safety or random compliance around it but by doing so what we found is in the facilities that they own. They had had some good rollout of that new process but as you look out across all of the affiliated facilities in the outpatient centers and you know they’ve had some turnover in key staff and there was you know areas where they had more than average turnover and people and the educational tools had been used but used by previous staff et cetera. But what they found was there was a very low level of compliance with this program that they were very proud of that they paid a lot of money to go on and so as they went and looked at that they realized well you know we never got the outcome from this engagement that we thought we were going to get because we weren’t completely implementing it and making sure that we had a standard implementation across the enterprise. And the interesting thing is if you use the rounding tool to ask the question, every couple of weeks are you doing it? Do you have problems implementing it? What are the outcomes in your area? But the more times you ask the more compliant people get with it and all of a sudden…

Saul Marquez:
Right.

Mark Crockett:
Now you start to see the outcomes in the other tools that show an increase in patient experience better, engagement with your clients, and frankly fewer of events because now you’re aware of what’s going on and that’s a very simple patient experience related thing. At a Cleveland Clinic, we have almost a thousand users of the rounding software that are gathering twenty eight thousand data points a month across all kinds of areas from medication administration to challenges with patient safety. And so if you have an outcome that you’re expecting from a change in your process Verge gets it done and Verge keeps it sustainably going. And then of course we have the other safety tools behind it to be able to prove that the outcomes are what you expect it to be. So it’s been really interesting. And so if you point to almost any area of hospital inpatient or outpatient operations, we can show you outcomes that are improving by just drilling people into this concept of seamlessly removing the randomness in process and getting people to a point where they’re doing the same thing or experiencing problems to develop you know there are areas where they’ve said boy this process that we did it doesn’t work in this area getting visibility in that so you can change that and then get the outcome. So we reduce variability usually but sometimes we come up with places where the variability is important and needs to be designed the process is that help a little bit?

Saul Marquez:
It helps a lot. And really it’s it’s you guys have developed a way to systematized compliance implementation thoroughness and then measurement and accountability in a way that’s very powerful.

Mark Crockett:
And that accountability part is unbelievable. I can tell you. And it’s funny how the accountability… what we found the accountability comes from is assignment of responsibility right at the time that you find the problem. So you know we have a rounding tool you’re walking through the unit you say “holy smokes you know what I’m seeing here is not in compliance. This thing is broken.” It’s not you know this is there’s a we had a hospital that had was looking at their malignant hyperthermia care. So this is a rare event that happens in surgery when a patient goes under anesthesia. And their core body temperature just goes up and up and up and it’s rapidly lethal rapidly causes brain damage. And so you have to act immediately. So having the carts handy with all the stuff on them and then having all of the staff understand what are three methods of cooling the patient that kind of thing they need to deal with do that right away. So you know being able to have people go find a problem, here’s a card that’s unlocked here’s a card that doesn’t have the medications on it. Here in this area there’s two or three people that when we talk to them they don’t know three cooling methods assigning it at that second to somebody in that area that’s responsible for correcting that and then tracking how long until that problem is fixed. So we have on the East Coast we have one of the health systems that is ranked easily within the top ten or twelve health systems in the country. And they went after this particular problem and they found that they are really good, 97% compliance is what they are reporting which sounds great but when you’re gathering eight thousand data points a month that means two hundred and fifty to three hundred medication related issues are slipping by. That is a recipe…

Saul Marquez:
Number.

Mark Crockett:
For all the problems that happen. This is how errors occur. And so the fact that we can look at their data literally from their iPad and say “Here are the last three quarters” and I can tell you with absolute authority that all but the last couple of weeks of issues are resolved, done, and the people are accountable and I can tell you exactly who is accountable for fixing that. That’s something that’s been lacking from healthcare for a long time. And it’s beautiful to watch.

Saul Marquez:
Yeah that’s definitely refreshing to hear Mark. And you know just thinking through the strategy of assigning it immediately and I think that’s definitely important an important part of the that you guys have had. Tell me about a time when when things didn’t work out so well and maybe you guys had some setbacks and how did you learn from those moments may you get away in.

Mark Crockett:
No no question. Right. I mean I think it’s important to build agility into your way of doing business and in the areas of product design in particular very very important. So we had a very important client that people working with who wanted to load in their medications from their formulary in order to be able to pick the right reason for the problem. So this patient had a medication you know I need to make sure that it works well. We loaded the patient’s formulary in because we weren’t as careful as we should be. We wound up with literally over a hundred thousand medications in one particular dropdown. So that’s completely unusable.

Saul Marquez:
Right.

Mark Crockett:
This plan is really good at administration and management. So they rolled that out and people used it which still boggles the mind. But the fact that you know when we realize what we’ve done and what kind of productivity problems we were creating for the client we of course changed our approach there fixed it and now it’s now it’s a beautiful thing but we never should have made that error in the first place and so you know that was some time ago. We have built out a wonderful process for understanding the client’s needs and just so much better of a way. So as we do our development we have more than 30 user groups a year each one of the products has both a national level and local user groups that has that is online. We have a major user groups through the year and then we have groups of people that we use to work directly with our developers. We’re always asking them why, what are the alternatives? Have you thought through what’s the real value of doing this effort? Is there any way to do it better or faster? This other client has told us that they think this is a good idea. What do you think? And what it’s led to is just tremendous usability our new tools my iPhone, first of all I can build these audits and compliance things in a matter of minutes. I can roll them out assign them to people for auditing and then they get an email click on it and it loads up in their iPhone or their android phone or whatever they’re using and it’s usable that we barely have to educate people on it. That is just a dramatic. So that’s something we should have done. We made the mistake we corrected the mistake and now our position with the company is in a stronger position.

Saul Marquez:
That’s great Mark and definitely kudos to you and your team for continually pressure testing and trying to break the technology on your own with these user groups and finding ways to to make it even better. Sounds like he has it made it really really seamless.

Mark Crockett:
It is our particular new tools are the client feedback has driven the success of them and the clients have been. This is an area of the hospital that has not necessarily had a lot of focus which is interesting because outside of healthcare, compliance is the way you get everything done. I spoke with the Malcolm Baldridge people last year and they were talking about… they ask the simple question, “How much time should we spend on preventing medical errors versus how much time should we spend on dealing with them when they happen.” And from the Baldrige perspective of course Baldridge across every industry they do airplanes and American cheese and they do gummy bears and potato chips you know. I mean they do every possible industry in every industry out there. The answer is you do as much preventative work as you possibly can justify. So at least 90% of your efforts should be on prevention and in healthcare because of the way we’ve been built, prevention had no value and so it really wasn’t a really core part of it. So you know our clients view prevention and safety as part of their core strategy to sell their quality to their investors, to the payers that are paying the bills, to the local community, to the large employers. So you know we work with a wonderful group of hospitals that are forward thinking that are really taking these compliance techniques and pushing them out there making them making the payments. It’s really neat.

Saul Marquez:
Love it. Now it’s this powerful work that you’re doing. Mark in and tell me about one of the most proud moments you’ve had to date.

Mark Crockett:
Oh man so there’s there’s a bunch of them just again to say I’ve got to share this with the great people I work with. There’s a lot of credit to be passed around here but our team was just awarded the number one in class ranking on credentialing. Credentialing in the old days was kind of a checkbox to say the doctor is who they say they are they have a license they have a DEA number and nobody has tried and they don’t have a criminal conviction. And so therefore they can work in your hospital. That has changed dramatically. So a symbol of our largest organizations use our provider tools in combination with our safety tools and our peer review tools to be able to run a very efficient peer review process to look at physician, nursing, and affiliated providers in terms of their quality and their effect on patient experience. And so you know we got that award because our clients are reporting we do a great job for them and they’re also reporting that the vision of this which is to have provider quality be just as important to the organization as the quality of the operations and the safety the operations that they see that as a continuum that our company manages with them and seeing some of the outcomes of that the clients are reporting. Gotta start a war and I think that represents a really significant thing for us right now. We are just couldn’t be more it only came out last week and we’re just fostering.

Saul Marquez:
Well congratulations on that.

Mark Crockett:
Thank you very much.

Saul Marquez:
And kudos to your team as well. Sounds like you guys are going above and beyond the call of duty which is definitely what we need in today’s day. How about a little bit about an exciting project or focus you’re working on today?

Mark Crockett:
Well you know we are focusing on credentialing and provider services but you know I think our rounding tools are accreditation regulatory. You know we’re really changing the way people do high reliability healthcare. High reliability, you’ve probably heard that from some of your other guests the concept of high reliability is a well-documented one outside of healthcare. Right. People know exactly how to do it. And it’s basically making sure that you fail one every five to the eight or nine times. So we’re talking about doing literally millions and millions of cases without a single failure. And so you know if you compare that with what you consider good efforts in healthcare of 97, 98, 99% it’s very different. And so you know one of the projects that we are doing is really at a number of our hospitals is using our compliance techniques coming from outside of healthcare and our compliance tools to create these incredibly safe facilities. Those are the kinds of projects that we’re really excited. And they’re a bunch of. There are a number of great hospitals are working with us on that.

Saul Marquez:
I’m sure the listeners are like okay Saul like seriously ask them how we can get in touch with them because we want to know. And so Mark of the provider organization leaders listening today wanted to reach out to you and find out more. What’s the best way to do that?

Mark Crockett:
We’re not shy and we’re easy to reach are mostly through our website www.vergehealth.com has a lot of information there. I am most often on an airplane somewhere so I’m much more difficult to reach but certainly not impossible. And if you just click the email link we’re quite good at getting to people so I encourage you reaching out to me through know if you connect them to be LinkedIn through the social media piece or you’re going to. If you want to just hit our website that’s the easy fast way to reach us.

Saul Marquez:
Love it. Great. Thank you for that Mark. Getting close to the end here, let’s pretend you and I are building on a leadership course in healthcare. So I’ve got five questions for you. These are going to be lightning round questions so I’ll ask and then you’ll give me some quick responses and then we’ll finish with a book you recommend to the listeners. You ready?

Mark Crockett:
Sure absolutely.

Saul Marquez:
What’s the best way to improve healthcare outcomes?

Mark Crockett:
Well we’ve done a lot of work in the EMR space and in clinical decision support. What we haven’t done is work on the process. So for me I assume nine thousand one is what every nobody does outside of healthcare. Why are we doing those kind of compliance techniques in healthcare? I absolutely believe that the way Cleveland Clinic and others are focusing on, compliance is a part of that high reliability technique is the best the biggest bang for your buck right now in healthcare without question.

Saul Marquez:
Love it. What’s the biggest mistake or pitfall to avoid?

Mark Crockett:
Not listening a great story on hips get a hospital that’s doing bundled payment or on hips and you know they’ve got one hospital that’s doing lots and lots of discharges to skilled nursing facilities.

Saul Marquez:
Okay.

Mark Crockett:
It turns out that when they said patients got to be able to walk across the room they weren’t listening to their people about what the rooms were like. So they were doing… one hospital was doing the patient has to walk across the room in their PT room which was 80 feet. And most of the rest of we’re doing them in the patient rooms which is eight feet. I want to meet these people who a couple of days after hip surgery can walk 80 feet right. Gotta listen your people, got to be aware of the operations, got to be out there in an organization gathering data not listening it’s a good way to really screw up healthcare.

Saul Marquez:
Love it. How do you stay relevant as an organization despite constant change?

Mark Crockett:
Again listening. So we have a very organized way of engaging with our customer base and I think that lots of hospitals are doing surveys around outcome, surveys around how patients are viewing their services. The best way to stay relevant is figure out what the biggest problem your clients have and fix it. And so you know hospitals are thick with people who have problems. Everybody’s got a health problem or they would believe me not be there. So you know I think of hospitals as a wonderful opportunity to work with people when they are in the most need.

Saul Marquez:
What’s one area of focus that drives everything in your company?

Mark Crockett:
The clients. So we work for the people that put their hands on people and try to cure them. And so we respect that. It’s our job to make them more efficient, make things easy for them. We need… we want to make their lives easier and better. So our mandate is clear and that’s one of the things I absolutely love about my job. If I was trying to make better potato chips I don’t know how to organize my life or that or get passionate about that. Are they more brown or more barbequey or whatever right. I mean I’m sure there’s somebody with passionate you’re passionate about the patient and the fact that we work for the people who put their hands on the patients. Hopefully they wash their hands right. That’s our job. But the bottom line is you know that’s easy to get organized and focus around that patient.

Saul Marquez:
Love it Mark. What’s your number one health habit?

Mark Crockett:
Well health habit. Exercise is important. Sleep is important. So both of those things I learned to try not to miss. So really focusing on getting exercise on a daily basis and really go to sleep on a daily basis.

Saul Marquez:
Love that. And what is your number one success habit?

Mark Crockett:
That’s an interesting point. I still see patients occasionally and you know I was ranked recently got my numbers back and I was one of the top in my group in terms of patients remembering that I washed my hands and so it was kind of funny how I delivered that those little phone dispensers and the way in the room and so I would get a couple of squirts of that alcohol foam on my hands and I would go in the room and I would walk toward the patient I would say “Hi I’m Dr. Crockett. Nice to meet you.” Put my hand out and they would grab a hold of my hand that’s just full of this alcohol stuff right.

Saul Marquez:
Yes.

Mark Crockett:
Why me and it’s gross and it’s disgusting. And they would go “oh” and then they would start to rub it on their hands and I would rub it into my hands and so we have both just washed her. And you know the patient never forgets it. And at the time I say you know our commitment to safety here to advocate health care is to make sure that you get the care you don’t get infection. And you know this is part of that commitment. And they loved it. So I mean just one little thing.

Saul Marquez:
That is awesome. I love that, great story. And what book would you recommend to the listeners Mark?

Mark Crockett:
Boy you know I read a lot and I love all kinds of literature. One of the books I read recently that was really fun to kind of go back and read is All Creatures Great and Small by James Herriot, it’s a story of small and large animal veterinarian back in the day. And really fun how it sounds like backbreaking awful work in some situations and yet it’s critical to the success of the community and just the wonderful stories OF the small community. If you’ve never read it, I highly suggest it.

Saul Marquez:
Love it. Love the recommendation Mark. Thank you for that. Listeners, you can get these resources on the website just go to outcomesrocket.health in the search bar type in Mark Crockett, Dr. Mark Crockett or type in verge health and you’ll see this episode pop up with all of the links and full transcript for you. Mark this has definitely been exciting and interesting. So I appreciate the passion you bring to the table. We’d love if you could leave us with a closing thought and in the best place for the listeners could get in touch with you.

Mark Crockett:
Again. vergehealth.com And I guess my last thought is lots of people know how to do things well outside in industry. In healthcare, we tend to focus on the problems we have instead of the solutions other people can bring looking outside of healthcare has been a real eye opening experience to me and I encourage you to get out of the healthcare experience and look for excellence in other places and see how you can bring it into your practice.

Saul Marquez:
Great words of wisdom Mark. Definitely appreciate you jumping on and looking forward to staying in touch.

Mark Crockett:
A pleasure.

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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