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

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

Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes, and business success with today's most successful and inspiring healthcare leaders and influencers. And now your host Saul Marquez.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This is exciting I'm ready.

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

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

What is the biggest mistake or pitfall to avoid?

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

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

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

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

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

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

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

Yes.

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

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

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

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

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

Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show notes, resources, inspiration, and so much more.

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