Leading the Way in Navigating Healthcare Complexity
Episode 396

Miles Varn, Chief Medical Officer, PinnacleCare

Leading the Way in Navigating Healthcare Complexity

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Leading the Way in Navigating Healthcare Complexity

Episode 396

Recommended Book:

The Emperor of All Maladies

Best Way to Contact Miles:

cmo@pinnaclecare.com

Mentioned Link:

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Leading the Way in Navigating Healthcare Complexity with Miles Varn, Chief Medical Officer, PinnacleCare transcript powered by Sonix—the best audio to text transcription service

Leading the Way in Navigating Healthcare Complexity with Miles Varn, Chief Medical Officer, PinnacleCare was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your audio to text in 2019.

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

Saul Marquez:
Welcome back to the podcast. Today, I have the privilege of hosting Dr. Miles Varn. He’s the Chief Medical Officer of Pinnacle Care. He’s responsible for bringing new medical advances to the Pinnacle Care team. Dr. Varn also is continually building Pinnacle Care’s network of top centers of excellence and top physicians around the world and is the chief contact with the distinguished Pinnacle Care Medical Advisory Board. He joined Pinnacle Care after 15 years of innovation and leadership at Inova Fairfax Hospital, a level one trauma center with seventy five thousand patient visits per year. In 2004, Dr. Varn was awarded the Inova Health Systems Service Excellence Legend Award for Extraordinary Patient Care. He is a member of the American College of Emergency Physician and American Academy of Family Physicians. He earned his medical degree from the University of Virginia School of Medicine in 1988, and since then has the patient at the center of everything that he does and is doing a phenomenal job with the work of Pinnacle Care to continuing that mission. So today we’re going to dive into the work that he and the and the Pinnacle Care team are up to, as well as some of his thoughts in general on the healthcare system and making it better. So without further ado, just want to welcome you to the podcast, Miles.

Miles Varn:
Thank you Saul, appreciate being here.

Saul Marquez:
Absolutely. And so did I leave anything out in that intro that you want to educate the listeners on?

Miles Varn:
Yeah. Just briefly add a lot of what I do these days is work with our strategy people. So in my kind of early life with Pinnacle Care, most of what I did and I still do a lot of it is go to the academic and other centers of excellence and understand their strengths and maybe their weaknesses and set up relationships and really get a picture of healthcare systems more rigorously. But now a lot of my time, I spend with corporate benefits, folks and strategies for basic Express Scripts. So I’ve really been fortunate to kind of see the interface between employer groups and other providers of healthcare in different ways. And then the top centers, people and providers. So it’s been a great journey to get here. But it’s also given me a great perspective on healthcare that I don’t think many people have that opportunity to see.

Saul Marquez:
Yeah, that’s really interesting. And I think I’m really glad you mentioned that because you think of who is paying for healthcare and a lot of it is insurance. A lot of it is employers. And I’ve seen a lot of change and more motivation from employers to really do more to curb the costs. And so be interesting to hear some of your thoughts on that. But before we jump into that, Miles, what got you into the healthcare sector?

Miles Varn:
Well, I come from a family of oral surgeons, father being father, great grandfather. And so I thought I was headed down that path. But my my father did volunteer work. And when I was 10, he took the whole family to Mexico for a month. And we traveled and did volunteer work in dentistry. And and then again, we went to Haiti when I was 14, which is an amazingly impoverished country that’s so close to the US. And I was his assistant. And in that experience, it really became more of a calling to do something to help people in the healthcare world. And for me, medicine was a better path than dentistry. Much to my father’s regret in some ways and respect in other ways. But that’s all I got into it. It really was seeing people who needed help and wanting to help those people.

Saul Marquez:
Wow. That’s a neat story, Miles, and really special that your dad took you on these trips and, you know, you didn’t get into dentistry, but you stayed in the medicine field then and now you have a greater appreciation for your passion for for caring for people and why that’s the North Star for you. So what would you say is a hot topic that needs to be on health leaders agendas today?

Miles Varn:
You know, I think navigation is really the hot topic in my mind. And I know that’s somewhat of a vague term. But by that I mean, the healthcare system, as we all know, is increasingly complex. From a technology perspective, from a pharma perspective, from an access to resource perspective. And so the ability for an individual patient to actually get to the place where the person or the people who can help them achieve the greatest outcome honestly and truly requires help. And I say that having help, family members and friends, it’s not easy. So I think we’ve got to provide patients and as clients with means to get out of a local system and they should get out of the local system or means to change providers what’s in their best interests, as we know as a company that… even though we objectively work with the individual patient, that’s all we care about. We know that that better care leads to better outcomes in terms of accurate diagnoses, accurate treatment plans, save surgeries. And so what I would say needs to be at the forefront is how do we get… help people get to those places and people that will lead to better outcomes for everyone, for them as an individual patient and for the system as a whole.

Saul Marquez:
I think it’s a great, great point. And navigation. Let’s face it, it’s not easy. And even as healthcare experts. Right, everybody listening to this, you could probably even attest it’s not easy to navigate. Imagine people that don’t know what you know about the health system. So I think you’re coming out with a really great focus area here. Dr. Varn. And so give us an example of of what Pinnacle Care is doing to make navigation easier, to improve outcomes.

Miles Varn:
So we we take the burden off of the patient. And by that I mean we understand their wants, wishes, likes, fears, in terms of their problem. And then we design a plan that fits their needs. So sometimes that might be looking in a case, looking at the records and saying, “you know what, you are doing all the things that you should do and you really shouldn’t change anything.” And I think it’s important at times for a patient to hear that, because it’s not only reassuring, but it’s not leading them down the rabbit hole of go see another provider. Go see another provider, get another. And so that’s one component. On the other side, then we do pathology reviews, for example, for any client we have with ductal carcinoma in site, too. We do a pathology, really. And the reason is we know in the literature there’s about a 30% chance of a missed diagnosis. And that’s high enough that at our cost we pay for an expert at either Johns Hopkins or Sloan Kettering to review those slides and give an accurate diagnosis, because quite honestly, pathologists as any physician are just human to have used their judgment. And we’re all flawed in that regard. So in that process, we’ve now had three women who were diagnosed with breast cancer, and one pathology review did not have breast cancer. Now, it’s a powerful thing in terms of the cost of radiation and chemo and surgery that would save their real dollars there. And I understand it’s important, but most importantly, these are women who would have gone through procedures they didn’t need. Who would have had a lifetime of survivorship, of surveillance, for a condition they didn’t have. They have to worry about their daughters and the impact. It’s a very powerful thing to change the direction of care by getting it right. So, you know, those have been our victories. But the times where we have simply taking advantage of the expertise that exists in the system and brought it to the patient for their benefit, we all win in that situation. Everyone wins.

Saul Marquez:
I think that’s a great example. And I mean, you can’t quantify in life. So that’s a really beautiful thing that you guys have done with the business and sort of the things that you guys give back. How do you give back now? I think about the timeline for somebody to join. It’s just when do they join? How did they get involved? And do people usually contact you guys when they’re deep in the trenches of fighting something or are they proactive? How does that work?

Miles Varn:
Yeah. So, you know, we have a diverse line of business. And so we started with individuals and families. And so for them, they were used to having advisors and we became the healthcare side of that. It makes sense for people who have the means of support. So that half of those people come to us without a specific problem. And our job is to help them achieve goals that ensure their longevity. So those are nutrition and fitness and sleep and stress management and bringing resources to help them achieve those goals. Because I tell people all the time, if you can’t pay someone to eat well for you and you can’t pay someone to exercise for you. You and you know that’s it.

Saul Marquez:
Amen.

Miles Varn:
And so on the other side, we have strategic partners and we have employers in which we take care of all their employees. And in those relationships, we’ve taken what was a full service relationship based, you know, all encompassing business. And we’ve broken it out on two experts’ second opinions, navigation, research, supports that educate the patient or identify clinical trials. Virtual consultations. Identification of top physicians for a particular problem. So those larger groups of people access at the first collection of services and we help navigate the patient to the right one for their situation. So again, and may you be just confirming you’re on the right path. Stay with it or it may be getting several opinions to help them understand and be fully informed about a complex medical situation. So as we’ve grown, it’s always been my mission to touch more people. And it still is. And so we. We’ve gone from families, maybe a thousand families in the beginning to now having almost three and a half million people who have access to our services. And that’s really one of the things that drives me every day.

Saul Marquez:
Tremendous. So at the beginning of the podcast, I sort of brought up the topic of healthcare sponsored by employers costs going up. What are you seeing there? You know, you mentioned it being one of the unique areas that you’ve gotten a glimpse at. What’s your take on that temperature and the changes and what’s happening there?

Miles Varn:
Yeah. You know, my take is that there is a lot of this diagnosis, there’s a lot of inappropriate treatment plans and there’s a lot of cost waste that goes into those two problems. And what we see in our data from our individual clients, not the high net worth necessarily that the individual clients is that we save about a 60% change in diagnosis, save about a 23% change in treatment. We save 8% of people we work with from surgery that they were going to have that they didn’t need.

Saul Marquez:
Wow.

Miles Varn:
And about half the people we work with change providers on the basis of our involvement in their healthcare. So it is low hanging fruit in terms of costs, because if you don’t get it right, for example, the women who didn’t have breast cancer, you don’t get it right in the beginning and everything that follows is gonna be a waste of money.

Saul Marquez:
Yup.

Miles Varn:
So I think, quite honestly, there are a lot of ways to change the way we direct patient. And it shouldn’t be either, you know, get stuck in one system referral process or get all boy referral process or those things that aren’t necessarily for the benefit of the patients specifically. We don’t need to set, noting a mindset that sometimes local care for complex problems isn’t the right solution. And maybe it’s regional care and yes, in network, because not a lot of people can get on a private plane and fly to Houston and live for six months. Yes, they have to stay in network. And yes, we have to find places they can drive to. They are not terribly inconvenient, but we can bring that expertise to the patient in the local or regional environment.

Saul Marquez:
What’s your take on medical tourism?

Miles Varn:
So it’s an interesting question. I think outbound medical tourism and we’ve been involved in both. There are centers that do it cheaper and they do it well. The trouble is a complication.

Saul Marquez:
Yeah.

Miles Varn:
You’ve gone on. You’ve had, you know, joint replacement in another country and you come back and suddenly there’s an infection. The trouble is, no one wants to touch it. No one wants that problem at that point. So there is risk and you know, there’s risk certainly here domestically, some kind of risk. But handling the problems…

Saul Marquez:
The follow up.

Miles Varn:
It’s just… exactly.

Saul Marquez:
Yeah.

Miles Varn:
Now, I will say there are some resources offshore and this is not necessarily for everyone, but the conventional medical system in the U.S. doesn’t manage something’s terribly well. There are not a lot of opportunities and some of their clients have decided to go offshore for stem cells or other treatments. And we’ve been involved in trying to vet those centers because the last thing we want them to do is go out of place. It’s going to hurt them.

Saul Marquez:
Yes.

Miles Varn:
But I you know my eyes have been opened to the fact that some conditions are not responding today and now to provincial U.S. based medicine. And those patients at least deserve the opportunity to know about good places that might be able to help them.

Saul Marquez:
Yeah. I think that’s a really worthwhile point. Gosh, it’s so interesting, right, that Miles, like we… we’re a global economy yet everything is so focused here on medicine. A lot of questions to be asked and a lot of things that you and your team could really help that out for employers listening to this and patients. Right. I mean, we’re all a patient. We all need the care. Why not get the best care?

Miles Varn:
Definitely.

Saul Marquez:
So tell us a little bit about a setback. Things have haven’t always been working really well for you guys. And we learned most from our failures. Can you share with us a story that things didn’t work out so well and what you guys learned from it?

Miles Varn:
Yeah. You know, this is kind of a personal story. So, you know, my wife had a little lesion on her kind of shoulder area. And it’s since she complained about it for a couple of months and I said, “well, I know it’s something bad, but you should probably have a dermatologist look at it.” And the dermatologist is a very well trained dermatologist at that and say “nothing bad, but let’s do a shave biopsy.” Three weeks later, we got a call, it’s a melanoma.

Saul Marquez:
Wow.

Miles Varn:
And it’s a pretty high grade melanoma.

Saul Marquez:
Oh boy.

Miles Varn:
Not at all what anyone expected.

Saul Marquez:
Yeah.

Miles Varn:
And now we’ve done a show biopsy. It’s gotta be excised. So I go in to my corporate mail and first thing I do is call one of my advisory board members who’s unknown and they do really well and then call another one. And then I get her set up with a top surgeon at Hopkins. And, you know, we spent an hour and a half with her and that was great. And then they were gonna schedule the surgery six weeks later. I get it moved up three weeks, you know, go with her to the surgery. And then everything turned out well. No complications. All good. Good margins. She’s now five years out and fine. But after that, I said to her, “you know you seem kind of disappointed for some reason.” I’m trying to understand what’s going on. And what she said to me was this and I’ll never forget it. She said, “you know, you are fantastic at your job and you did a lot of good things. But what I needed was a husband. And, you know, I needed someone to address my fears and know that I didn’t need someone to be my navigator or advocate.” And that was a very powerful message. And it woke me up to the fact that there are so many people who have to serve that role and they really need to be a husband or wife to the patient. They need help with all the logistics so that they don’t have to do that. And it’s certainly made it clear to me that compassion and that shoulder to cry on and that fear is a real thing for the patient that needs to be considered by all of us who were involved in healthcare. You got to keep your eyes open to it. It’s too easy to get into do it mode rather than feel it mode.

Saul Marquez:
Now that is such a great message, Miles. And it’s like, yeah, you just put your head on, right? I mean, that’s what you do. But wow, that’s a good reminder that we have to be there emotionally as well as getting all of the logistics done.

Miles Varn:
Absolutely. You know, it’s… I understand now that the patient perspective and then critical in terms of engaging patients and helping my team engage patients.

Saul Marquez:
Wow. That’s a great story. And I’m glad your wife’s doing better now.

Miles Varn:
Well, thank you. Thank you.

Saul Marquez:
So that’s one side of the coin. How about on the other side? Give us one of your proudest medical leadership experiences.

Miles Varn:
There are a couple of… I’ll give you two. One was we were referred to our company, someone who was on the board of India, Anderson, at one point at the time. And he was referred to ask for help because he had just been diagnosed with prostate cancer. So it’s quite an honor to be able to take someone who’s being referred by an institution that is a cancer center. And you know, that that made me proud of our team, that we had established ourselves as a leader in a way that even the leaders in some ways looked to us for help, that they’re important people. Second story is it is really a case story. We took care of this retired Brigham trained thoracic surgeon down in Orlando and he’d come to us. His granddaughter… and he was diagnosed with Lewy body dementia. She said, “look, I just want to make sure there’s nothing more out there for him. This is it. That’s fine. He had moved from independent living, assisted living, assisted living with help.” And, you know, I talked to him and he was confused at time, but lucid at other times. And we went through his records. And I’m not a neurologist, but I read through the records. And I had been seen in Mayo, Jacksonville, and there had been some some consideration of a condition called negative pressure, hydrocephalus. And I gave the records to my medical director and I said, look, read through these. “Let me know what you think.” And he said, “I think the normal price right to someplace.” So we we called his local neurologist to try to get a procedure done to help diagnose him. And the neurologist actually wrote a letter back saying this is not the right advice for all of us. So we got him an appointment at the Brigham where he trained with a neurologist who was willing to see him on a Saturday for two hours. And, you know, you have to understand, this is someone is intermittently confused, intermittently incontinent, intermittently unable to walk without assistance. So we arrange everything. It slows. So we’ve got that to grow in there. But he has the appointment. The neurologist says, I think he has normal pressure, hydrocephalus. They do the tests they needed. They’ve proved that they put in a shunt and he went from assisted living or fell back to independent living. He got his driver’s license back. But what he had told me a year before, shortly after New Year’s. He said, “you know, the one thing I miss the most is dancing with my wife on New Year’s Eve. We’ve been married 60 years.” So he called me following New Year’s after he had recovered. And he said, “I just want to let you know I danced with my wife this New Year’s.”

Saul Marquez:
That’s awesome.

Miles Varn:
So those sort of victories are quite the victory that inspire me they’re the individual patient experiences. For a guy like that You know the granddaughter said “we have our grandfather back.” It’s all about that for all of us. That individual patient.

Saul Marquez:
That’s wonderful. What a great story. And gosh, so many people get lost in the system. And, you know, it’s nobody has a foolproof solution. So I think it’s great to have the the option, the expertise, the persistence that your team provides. So what about the most exciting project or focus you guys are working out today? What is it?

Miles Varn:
So we… we’ve become powered back and member of academic institutions for anyone wanting virtual opinion. So remote second opinions. So we do this for Sloan Kettering. We do it for Yale. We do it Larry Children’s and some others. And so the volume in those cases is becoming increasingly larger and larger. So people from all over being able access top resources, with our help. So we now see probably between two and three cases a day going to experts at Sloan Kettering alone. And we see what’s going back out into the field in the way of advice direction, mint position to position the potential impact that can have. So we’re expanding those resources, we’re growing those relationships. And again, with the goal of bringing expertise to more people, better outcomes for everyone, including the employers, the payers, but most importantly for those individual patients.

Saul Marquez:
Wow. That’s really powerful and interesting. And why not? We have the technology. You guys have established the network. Why not? I think it’s great. So Dr. Varn, getting close to the end of the interview here, we’re going to do a lightning round. So I’ve got a couple of questions for you, followed by your favorite book for the listeners. You ready?

Miles Varn:
Okay.

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

Miles Varn:
You’ve got to engage the patient and you’ve got to navigate them to the right resource with their particular problem in a personal way.

Saul Marquez:
I love that. The empathy there. What is the biggest mistake or pitfall to avoid?

Miles Varn:
It’s to assume that one engagement strategy is going to work. It’s not about portal. It’s not about an app. It’s not about a website, it’s about a human being connecting with another human being. That’s what’s going to lead to better engage.

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

Miles Varn:
We were 18 years old. We’ve always gone one way and then another way. And I tell our folks all the time that, “you know, if you think the way we’ve always done it is the way that’s going to work for the future, then we’re done now.” So we we constantly look for ways to evolve into a better company. And stagnation is really not something that’s a part of our culture. We encourage creativism with ideas and with solutions. And quite honestly, some of the best solutions have not come from our physician team, but they come from the non physician people we work for.

Saul Marquez:
Powerful. And what’s an area of focus that drives everything at Pinnacle Care?

Miles Varn:
It’s compassion. Quite honestly, you know, we have a culture of compassion. And, you know, some of what I talk about in terms of my background growing up and my personal experiences in the inn, we work in an open environment. I hear people talking to the client and it comes across as sincere and caring. And that is our culture across our entire group of business, even though the folks who sweep the floor. One of our companies, we make sure that that person gets the same treatment as the billionaire. That’s important to us. It’s all the same. It’s all about compassion.

Saul Marquez:
Love that. These next two are more on a personal note for the listeners to get to know you. What is your number one health habit?

Miles Varn:
I am a triathlete, so…

Saul Marquez:
Cool.

Miles Varn:
I’ve done Ironman competition…

Saul Marquez:
Oh you have?

Miles Varn:
And less so… and I’m more in the realm of Olympic. The Iron Man.

Saul Marquez:
Yeah.

Miles Varn:
My wife does say so that, you know, the kind of five hour bike ride on a Saturday and in the high five and then I go out for five hours, just doesn’t work for our kids schedule. So for me, it’s all about exercise. I think exercise is a powerful medicine.

Saul Marquez:
That’s awesome. And how about your number one success habit?

Miles Varn:
I would say number one success habit is to not sweat the little stuff. There’s so many things in this professional world and even a personal world that little things that can be big things if you let them be big things. And you’ve got to move past the little stuff and look at the big picture. And even in a personal level, the road to longevity is riddled with failures and how you handle those failures is really what makes you succeed or not. And so I think it’s important to not be too hard on yourself for not being perfect.

Saul Marquez:
That’s a great one, Miles. And what book would you recommend to the listeners?

Miles Varn:
So I like The Emperor of All Maladies by Mukherjee. And part of it is an amazing story about the development of car t cell therapy, it’s a very hopeful book. And I encourage people who might be in a position to take advantage of that innovation to read it, because the message is that no one I believe that we have a system in this country that is the world’s best by far, despite all the money that we throw at it. So forth. We have unique resources and we have researchers who are doing the best research and you read that book and you come away feeling very powerfully motivated to be a part of it.

Saul Marquez:
Great recommendation. Folks if you want to get the full transcript of our discussion with Dr. Miles Varn from Pinnacle Care, go to outcomesrocket.health in the search bar type in Pinnacle Care or type in Varn and you’ll find all of that there, including the show notes, the short notes, the long notes, links to all the things that we’ve discussed. Miles, this has truly been a pleasure. I love if you could just leave us with the closing thought and then the best place where the listeners could reach out and continue the conversation with you and your team.

Miles Varn:
So the best ways to find us is www.pinnaclecare.com or me cmo@pinnaclecare.com. And a closing thought is this. And whatever you do in healthcare, I encourage you to always consider the patient. That’s what we’re here for. It’s not about costs in terms of physicians or physician leaders or about administrators or people doing the work. In the end, it’s I help patients, it’s all about you and make decisions that are right for you. And your decisions might be different than my decisions. But you want to be fully informed and make what’s right for you at the time. So that’s my message. Thank you all for listening. Thanks Saul for having me.

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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