Healthcare was not a major focus during the 2024 election where other key issues drove most of the discussion. This left a vacuum around specific healthcare policies and what to expect from a second Trump Administration. With few details available and political capital to spend from the ‘red sweep’ this election, healthcare stakeholders are pondering how much of the incoming administration’s preference for disrupting the status quo will extend to the healthcare industry.

For the third episode in a four part series on election implications – and the first one since votes were counted and winners declared – JP Morgan analyst Lisa Gill joined Keith Figlioli on the Healthcare is Hard podcast to analyze the outcome.

Lisa has more than three decades of healthcare industry experience and has spent most of her career at JP Morgan where she has been covering the healthcare services industry for the last 27 years. In this episode, Keith talked to Lisa about the lessons she’s learned covering healthcare for several decades, and asked her to share her outlook for what to expect in the months and years ahead. A few of the topics they discussed include:

• Cycles of innovation. Thinking about how the industry has evolved over time and how healthcare organizations have had to continuously reinvent themselves, one of the main observation Lisa makes is that common themes and trendlines often repeat themselves. She cites the pharmaceutical industry as an example, comparing the cycle of pharmacy innovation when she started as an analyst in the late 1990s to the current wave of innovation that’s occurring now.
• Consolidation and diversification. With a philosophy that leans towards deregulation and loosening oversight, one expectation of the incoming administration is that it will create more opportunity for M&A. Lisa talks about the trends driving consolidation in the industry and how it’s not just about diversifying earnings and revenue. She says it’s about broadening the touchpoints organizations have with patients in order to reach the goal of finally being able to deliver truly integrated care.
• Optimism for managed care. If early returns in public markets after the election are an indication of what’s to come, managed care organizations are in a good position to thrive under the second Trump administration. Lisa points to the fact that managed care companies outperformed the day following the election, rising 5.8% while hospitals fell more than 4%. With a friendlier environment for reimbursement rates and STAR ratings, and a lower bar for M&A, she expects this trend to continue.
• Previewing the 43rd Annual JP Morgan Healthcare Conference. This venerable event sets the stage on what to expect in healthcare for the year to come. And while it takes place before the presidential inauguration, signals from the Trump transition team, including announcements about appointments to cabinet positions and healthcare agencies, will drive the conversation. However, Lisa believes the industry won’t have a clear view into the new administration’s focus and priorities for healthcare until well into the first quarter of 2025.

To hear Lisa and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

With the White House and Congress up for grabs this election, anticipation in the healthcare industry is high. Shifts in healthcare policy will influence how care is paid for and delivered, which will of course influence the flow of investment dollars in both public and private markets.

During the first episode of a four-part series on election implications, beltway insider Julie Barnes laid out potential scenarios for the direction healthcare policy might take depending on election outcomes. With that background, Part 2 of the series zooms in on healthcare investing. 

For more than 20 years – and now six presidential election cycles – Richard Close has covered the healthcare space as a Wall Street analyst. He was one of the first analysts covering healthcare technology and as Managing Director, Digital and Tech-Enabled Health Equity Research at Canaccord Genuity, he focuses on introducing the investment community to disruptive and innovative companies that are leading the digital transformation in healthcare. 

In this episode of Healthcare is Hard, Richard talked to Keith Figlioli about the election and how it could impact investments in the healthcare sector. A few of the topics they discussed include:

• Predictions on priorities. Healthcare has not been a major focus this election cycle and Richard doesn’t believe either candidate has shared many specifics about their plans for health policy. But he discussed general expectations like an increase in Medicare drug price negotiations under a Harris Administration, or giving states more control of Medicaid under a Trump Administration. Regardless of who takes the White House, he sees an increasing focus on addressing employer health costs, driven by forecasts for an 8% increase next year – the highest jump in more than a decade.
• Contrasts in public vs. private markets. Richard says healthcare investors in public markets tend to “paint with a broad brush” and are focused on the short-term. Because of this, he says struggles at large-cap managed care companies in recent years have influenced overall investor sentiment. Once these companies get beyond current challenges and start hitting their numbers, he believes it will open the market and drive improved valuation for smaller and mid-cap companies. On the other hand, Richard says investors in private markets look more deeply into sub-sectors and are placing bets for the long run. 
• Optimism for health tech. With healthcare accounting for 20% of the economy and continuing to grow, Richard sees technology as a primary lever to help bend the cost curve. He’s optimistic about the future opportunity for investors in both public and private markets, and sees an opportunity for the IPO window to potentially open up after the election. He says there are a handful of companies that are profitable and have been growing revenue that may be ready to test the IPO market in 2025.

To hear Richard and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Through its work with more than 41,000 healthcare facilities and the industry’s largest database of patient feedback, Press Ganey gives organizations the data and insights they need to put the human experience at the center of healthcare.

Since it was founded nearly 40 years ago by Professors Press and Ganey at the University of Notre Dame, the company has built a reputation for being the prominent source of patient feedback, but it hasn’t stopped there. Its solutions capture the voice of the patient, physician, nurse, and employee to keep healthcare focused on people by enabling organizations to address safety, clinical excellence, patient and member experience, and workforce engagement.

Pat Ryan became CEO of Press Ganey in 2012 after more than 30 years working with healthcare leaders and providers, including a dozen years as a Press Ganey client. Pat has served on several health system boards and has worked throughout his career to improve the quality and safety of care while lowering cost and achieving caregiver resilience to deliver truly patient-centered experience.

In this episode of Healthcare is Hard, Pat spoke with Keith Figlioli about the increasing focus on human experience in healthcare transformation. Drawing knowledge from his career and from Press Ganey’s unrivaled understanding of patients and the professionals who serve them, Pat shared his perspective on topics including:

• The link between patient experience and financial success. Pat shared what he says is a little known fact – that health systems across the country with the highest margins also have the highest patient scores. He talked about how the two are linked and how value leads to long term community loyalty. He cited his time on the board of Beth Israel Deaconess Medical Center where they looked at patient data first and financial data second. He says health systems today need a comprehensive view that also includes safety and employee engagement data in order to identify opportunities for improvement.
• Redesigning healthcare from the outside in. Any consumer business would start with the needs of the customer first and work backwards to design systems that add value. But healthcare wasn’t created that way and was built from the inside-out. Pat discussed the need for healthcare organizations to continue the long journey of recognizing that consumers comes first, and talked about how workforce engagement will be an important component of that as the industry evolves.
• The trust factor. Pat describes how organization can map trust in order to understand where it breaks down by identifying friction points within the customer journey. He talks about how important it is to build and maintain trust in all relationships – not just a patient or family’s trust in an organization, but also nurse, clinician and employee trust in their organization and leadership. He mentions how important this is for payer organizations that are especially susceptible to unfair or inaccurate perceptions.
•  Opportunities for innovation. When discussing areas where healthcare organizations can improve, and where innovators in the space can help them, Pat’s focus during this conversation was mostly on two issues – home care and the shift towards value. He says figuring out how to care for more people at home is going to be critical and sees opportunity around redesigning the healthcare workforce for the gig economy. He also talks about how slow the movement to value-based contracts has been and how a major break in the system may finally force congress to act if adoption doesn’t pick up.

To hear Keith and Pat discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

This is the final episode in a four part series with heads of strategy at providers and payers from across the healthcare ecosystem to explore “the new normal” in a post-COVID operating environment. For this episode Keith Figlioli welcomed Sukanya Soderland, Chief Strategy Officer at Blue Cross Blue Shield of Massachusetts, to explore how a regional payer is adapting. This follows previous episodes that offered a diverse perspective from heads of strategy at:

• A regional health system, OhioHealth (Episode 58)
• A national health system, CommonSpirit Health (Episode 59)
• A national payvider, Humana (Episode 60)

To wrap up this series, Sukanya provides a glimpse into the strategy at BCBS MA, the largest health plan in Massachusetts and a mostly commercial-focused payer that serves nearly three million members across New England. Unlike most not-for-profit organizations, BCBS MA pays significant federal, state, and local taxes and assessments. Without soliciting or receiving charitable donations, or benefiting from tax-exempt financing, BCBS MA stays competitive by generating a small margin from operations that it reinvests in its business, people, and technology, and by remaining deeply focuses on the community its serves.

In her discussion with Keith, Sukanya shared her outlook on issues including:

• Shared empathy between operations and innovation. For any head of strategy, serving the immediate needs of an organization is equally as important as anticipating and planning for future demands and market forces. Sukanya discussed how business leaders can sometimes view innovation leaders as out of touch with current realities, while innovation leaders might view business leaders as “dinosaurs.” She talked about the importance of developing a culture of empathy and trust between these groups.
• Building vs. buying vs. co-designing. To stay competitive against larger, national organizations, regional payers must recognize what they do well and where they should partner with other like-minded entities to augment their capabilities. Sukanya talked about making decisions to partner or co-develop capabilities with others, including sister companies across the Blue Cross Blue Shield Association, as a way of advancing sustainable, non-profit healthcare. She also recognized the challenges with driving meaningful change in affordability, quality and consumer experience without being intimately involved in care delivery, and discussed creative ways of partnering with incumbent health systems or new and innovative care delivery models to make that happen.
• Changing dynamics in how people access care. One of the biggest changes Sukanya sees occurring over the next decade is the way people access care. She discussed several of the market factors driving this change from the supply and demand of primary care physicians, to Generation Z aging into adulthood. She talked about how healthcare is losing the “quarterback” function as young adults turn to social media, trusted contacts and convenience in place of a strong relationship with a primary provider, and how that impacts strategy.

To hear Keith and Sukanya discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

The previous two episodes of Healthcare is Hard explored the “new normal” from the provider perspective with heads of strategy at an innovative regional health system, OhioHealth, and one of the nation’s largest, CommonSpirit. For the third episode in this series, Keith Figlioli welcomes Humana’s Chief Strategy and Corporate Development Officer, Dr. Vishal Agrawal, to shift the discussion towards payers and how they’re adjusting to the post-COVID world.

Today, Humana is one of the nation’s largest health insurers that also provides payer-agnostic primary care, home health and pharmacy services through its CenterWell brand. However, delivering health care services is not new to Humana. The company’s roots date back to the 1960s where it began as a nursing home business, and by the 1990s, it grew to become the nation’s largest hospital company. While its care delivery assets eventually merged into HCA Healthcare as the company focused on insurance, this deep history provides a unique advantage as the industry continues its shift towards value.

In this episode of Healthcare Is Hard, Dr. Agrawal shared some of the strategic priorities for Humana as he helps the organization navigate the new normal in healthcare. These include:

• Breaking the facility-centric model. The pandemic forced healthcare organizations to think differently about where and how they operate, accelerating the adoption digital and in-home solutions. For Humana, Dr. Agrawal describes how this was a focusing mechanism to help the company think about what it does best, and how it could enhance and integrate those pieces to deliver a more omni-channel approach to healthcare that people desire. This included doubling-down on the primary care, home health and pharmacy services Humana delivers through CenterWell and creating an integrated delivery system with a core focus of keeping people healthy. With this strategy, and a business especially well-suited for the Medicare Advantage payment model, Humana also announced in early 2023 that it would exit the commercial insurance market to focus on government-funded programs.
• Chronic care management. In a health system that was designed around the fee for service model and does a wonderful job treating conditions for sick care, Dr. Agrawal believes one of the biggest missing pieces is a similar focus on chronic care management. He’s excited about the opportunity for building an integrated delivery network (IDN) that brings together high touch areas that can manage chronic health conditions more proactively, and is optimistic about the ability of the Medicare Advantage model to help push the industry in that direction.
• Removing waste from the system. Dr. Agrawal points out the extreme waste in the healthcare system – which by some estimates surpasses $1 trillion annually – and how eliminating that waste should be a key focus for everyone. He talks about opportunities for reducing avoidable admissions and ER visits by keeping people healthier and innovating in areas like nephrology, cardiology or oncology where much of the disease and health burden exists.
• Consumer choice & personalization. Healthcare is intrinsically personal and as a result, requires many different options for people to choose what’s right for them. Dr. Agrawal describes how Humana is tailoring plans to meet these needs and uses the example of the Humana Honors Plan that it built in partnership with USAA around the capabilities of the Veterans Health Administration. He believes we’ll see more customization in areas like this as healthcare becomes a more consumer-driven market. 

CommonSpirit Health is one of the nation’s largest integrated health systems comprising 142 hospitals and 2,200 care sites across 24 states. Three years ago, at the height of the pandemic, CommonSpirit’s Chief Innovation Officer, Rich Roth, and now former CEO, Lloyd Dean, spoke with Keith Figlioli on the Healthcare is Hard podcast to discuss their approach to leading the organization through healthcare’s most challenging times. As the country emerges into a new normal, CommonSpirit’s Chief Strategy Officer, Sheri Shapiro, joins the podcast to discuss how she’s leading this large organization with diverse markets and service lines into the future.

Sheri recently joined CommonSpirit to lead strategy in June 2023, undertaking a wide ranging role that spans responsibility for market strategy and development, growth and partnerships, strategy transformation, innovation, marketing and communications, brand management, the international division, sales and payer strategy. She brings more than 20 years of healthcare management consulting, health system leadership and brand management to the position, including seven years leading strategy at another one of the country’s largest health systems, Trinity Health.

In this episode of Healthcare Is Hard, Sheri talked to Keith about how she views the new normal and how she’s helping CommonSpirit navigate these uncharted waters. Some of the topics they discussed include:

• Guiding principles for a large health system. Sheri described the three most important things she evaluates for setting high-level strategy at a large health system. First is defining the common thread that a health system will be known for across all sites – the one unique advantage and competitive differentiator. Second is setting individual market strategies that align with the fundamentally local nature of healthcare delivery. Third is the operating model of the company, which serves as the glue that holds system and market strategy together. Without a model that enables local markets to operate efficiently while leveraging “systemness” and scale, Sheri says a large health system will be unable to execute. 
• Portfolio rebalancing. Sheri talked about how the new normal has been impending for quite some time, citing examples like the shift from inpatient to outpatient starting more than a decade ago and challenges with rising costs growing for even longer. With events including the pandemic accelerating the need to transform, she talked about her beliefs around portfolio management and thinking through how to best deliver every service across the system and in each market. This includes examining the organization’s presence in every market to ensure it’s playing an essential role, and where it’s not, looking for opportunities to transform. 
• Misconceptions of healthcare economics. Most people have a gross misunderstanding of healthcare finance and how different it is than other industries. Sheri discussed the mix of fixed and variable costs in healthcare and the inability to control revenue like other industries can. She used the simple example of restaurants that have trouble hiring and can adapt by paying staff more and raising prices almost immediately – a level of control healthcare providers just don’t have. She says there will have to be a fundamental change in the economic model of healthcare, and without policy reform, she says it will impede the industry’s ability to transform.

To hear Keith and Sheri talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

There are many reasons why central Ohio is a fertile ground for innovation and why the areas surrounding Columbus are ideal for testing new approaches to consumer behavior. It’s a diverse city with five Fortune 500 companies and 19 Fortune 1,000 companies in a wide range of industries, from banking and insurance to fashion. No single industry contributes more than 18% of GDP and together, they bolster a region that’s experiencing active and sustainable growth. In addition, Columbus has a relatively low cost of living, temperate climate and demographics that are reflective of the country at large. The bottom line is this well-balanced community creates an environment of low volatility that makes it an ideal place to try new things.

These attractive attributes extend to healthcare as well. Central Ohio has a diverse payer market where no one payer holds more than a third of market share. Several leading health systems support the community, including OhioHealth, which is one of the largest. OhioHealth is a faith-based, nonprofit system with 35,000 associates, physicians and volunteers, and a network of 14 hospitals, 200+ ambulatory sites, hospice, home health, medical equipment and other health services spanning 47 Ohio counties.

As OhioHealth’s Chief Strategy and Transformation Officer, Michael Krouse is responsible for the future direction of the organization and ensuring a strategic framework that delivers operational excellence and growth by meeting consumers’ needs with a diverse portfolio of services. Michael joined OhioHealth as CIO in 2007 after spending the previous 20+ years in healthcare executive roles at UW Medicine, First Consulting Group, E&Y and Arthur Young in the Pacific Northwest.

In this episode of Healthcare is Hard, Keith Figlioli spoke with Michael to explore “the new normal” in healthcare and what the industry will look like at it settles into the post-COVID world. Michael discussed his perspective and predictions on the new normal including:

• The sweet spot of scale. As a $6 billion health system, OhioHealth is a growth company at its core. But Michael says the path to becoming a $20 billion system is not as urgent as it was a few years ago. He points to health system megamergers and the difficulties those organizations have had driving ROI, and discusses how the market is rewarding systems with greater focus.
• Lumpy operating margins. While volumes are recovering in many places around the country, margins are still inconsistent for most systems and the rebound is not enough to avoid making tough decisions. With margins that are less than what’s required to fund growth and capital for many health systems, Michael foresees the need for major decisions around cost savings and efficiency that will be required for survival.
• Spinning up new business lines quickly. The healthcare industry is not historically known for quickly or successfully establishing new business lines where it lacks experience. Michael believes this will have to change in the new normal and says one path to success is through partnerships. He discusses examples of OhioHealth’s partnerships with ChenMed, Privia and Devoted Health and how they helped deploy new capabilities far more quickly than doing it alone.
• Inside innovation ecosystems. Michael shares his strong beliefs on the strategic role venture capital and private equity relationships can have helping health systems anticipate market needs and transform in a way that differentiates them. He talks about OhioHealth’s approach to strategic investing and business incubation, and how it’s always driven by the operational interest of the health system.

To hear Keith and Michael talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Before taking responsibility for operational performance of Booz Allen Hamilton – the $9+ billion technology and consulting leader with 32,000+ employees worldwide – Kristine Martin Anderson built a career pioneering healthcare IT. Most notably, she spent nearly 14 years at an early innovator in the space, CareScience, where she helped advance work in quality measurement before overseeing the launch of the nation’s first web-based clinical decision support system for hospitals, and the nation’s first health information exchange, among other groundbreaking initiatives.

After CareScience, Kristine joined Booz Allen in 2006 to help grow, and ultimately run, the firm’s healthcare business. Kristine later became president of the firm’s civilian sector and ultimately ascended to her current role as chief operating officer. Nearly all of Booz Allen's business is through government contracts, and its clients include all of the cabinet-level departments of the U.S. federal government, from defense and homeland security, to transportation and public health.

Kristine’s extensive work with the government and experiences pioneering healthcare IT put her in a unique position to navigate the complex demands of the healthcare industry. She shared some of her knowledge with Keith Figlioli in this episode of Healthcare is Hard, where they discussed topics including:

• Advice for winning government contracts. Kristine’s biggest advice for organizations looking to drive healthcare innovation through government contracts is that it’s not a good side gig. She says working with the government is a commitment because it’s a customer with long sales cycles, unique requirements and a need for transparency. But it’s also a big customer, which she says has the best missions and really important tasks that have to get done.
• How AI adoption will be slow and uneven. Kristine shares the industry’s excitement for artificial intelligence (AI) and its potential to transform healthcare, but offers words of caution around expectations for rapid, widespread adoption. She points to the example of using AI to analyze radiology images – one of the first applications of AI in healthcare – and the fact that it has still only reached 2% of all images. She also predicts and discusses why government policy makers will be more reactive than proactive when it comes to regulating AI innovation.
• The state of quality measurement. “Culture is eating strategy for lunch in the measurement world,” according to Kristine. She says quality measurement has lost its way as an unintentional consequence of Meaningful Use and the movement towards linking quality measures to health IT. She laments how meaningful data still isn’t available to the public in a way that can help inform personal healthcare decisions and says reporting has become more about getting government incentive for healthcare organizations.
• Prospects for entrepreneurs. The need for innovation in healthcare is bigger than it has ever been before, and Kristine is optimistic about the ability to empower startups and the people behind them to change the world. Her advice for entrepreneurs is to closely monitor the issues that will affect adoption. She points out how the best ideas don’t always prevail and says that focusing on levers for adoption is just as important as an innovation itself.

To hear Keith and Kristine talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Earning a Presidential Management Fellowship after law school gave Kristen McGovern firsthand experience working inside many of the agencies and offices that drive U.S. healthcare policy. Over a two year period with the Department of Health and Human Services (HHS) she worked at organizations including the National Cancer Institute and the Biomedical Advanced Research and Development Authority (BARDA). She eventually landed at the Office of Management and Budget (OMB) just as the HITECH Act was signed into law in 2009, dedicating nearly $30 billion to modernizing healthcare IT.

As the executive office that oversees the federal budget and federal agencies, Kristen worked closely with leadership at OMB and HHS as they deployed funding for Meaningful Use and other programs catalyzed by the landmark legislation.

In 2010, around the same time the Affordable Care Act was passed into law, Kristen was recruited by Farzad Mostashari (a previous guest on the Healthcare is Hard podcast) and became chief of staff at the Office of the National Coordinator for Health IT (ONC).

These experiences launched a career that has put Kristen at the forefront of federal healthcare policy and politics. She is currently partner at Sirona Strategies, a healthcare consulting firm she co-founded to advise organizations – from startups to the Fortune 500 – on healthcare policy.

Some of the topics Kristen talked to Keith Figlioli about on this episode of the Healthcare is Hard podcast include:

• A pulse check on DC. Kristen shared insight into the offices and agencies shaping the healthcare industry from inside the beltway. For example, she talked about the current state of the Center for Medicare & Medicaid Innovation (CMMI), the activity she says is happening “below the surface” and how the organization is at an inflection point after more than a decade testing payment and delivery system models.
• The evolution of Meaningful Use. Looking back at her time at ONC, Kristen talks about the initial goals of encouraging EHR adoption to unlock insight from paper records that were sitting in filing cabinets. She talks about progress the industry has made and the current goals of making sure organizations can access and use data in new and innovative ways. In other words, ensuring we haven’t just created electronic filing cabinets.
• The size and scope of AI Policy. With all the enthusiasm about artificial intelligence (AI) in healthcare, Kristen talks about the process of putting guardrails around this powerful technology. She says it will require a large-scale collaborative effort across HHS and other government agencies, and believes it will ultimately be an even bigger undertaking than Meaningful Use.
• Policy advice for startups. As a highly regulated industry, every organization that touches healthcare needs to be aware of the impact current and future policy decisions could have on their business. Kristen shared advice about how she helps startups think through the impact of policy decisions, and when and how to embed policy experts in a business.

To hear Keith and Kristen talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Peter Durlach grew up around computers and was exposed to innovative technology at an early age by his father, who helped run a lab in the electronics department at MIT. After graduating college in the 1980s, Peter caught the entrepreneurial bug way before it was cool, and was employee number four at a company developing the first voice user interface for the Macintosh.

Peter’s work put him at the center of bringing voice recognition and artificial intelligence (AI) to healthcare – work he continues today as EVP and Chief Strategy officer at Nuance Communications, a Microsoft Company.

At Articulate Systems, the first voice recognition company Peter helped build, he and his team eventually recognized that 60% of their user base was physicians dictating medical notes. He helped pivot the company to focus exclusively on healthcare and build the technology that became PowerScribe, a solution still used by most radiologist today.

Through acquisitions, Articulate Systems eventually became Nuance. After some time away from the company as a software consultant and running an AI-powered contact center business he sold to Microsoft, Peter was recruited back to Nuance in 2006 to create its healthcare division. By 2019, Nuance was focused on the healthcare and customer engagement market, and in 2022 was acquired by Microsoft for $20 billion.

In this episode of Healthcare is Hard, Keith Figlioli builds on earlier conversations with guests like Mayo’s John Halamka and Advocate’s Rasu Shrestha to unpack the hype around AI in healthcare and understand what’s real right now, and what will be in the future. Some of the issue Keith and Peter discussed include:

• The AI adoption curve. Peter described the different adoption curves he sees for different use cases of AI in healthcare. He talks about how adoption of administrative use cases will happen much faster than clinical applications, and the factors that will influence adoption curves – from performance requirements to governance and patient safety.
• Use cases that matter. Nuance and Microsoft see one common theme for the application of AI in healthcare – that it should be a copilot and not an autopilot. In the near term, the major focus will be on automating administrative tasks in revenue cycle, payment integrity, documentation or other areas where there is a large labor expense. While automation may be able to accomplish 30% of the work in some areas, and 70% or more in others, the goal is reducing labor while maintaining human oversight. The bar is much higher for clinical use cases, but the same rules apply.
• Opportunities for startups. Peter shares lessons from his time at startups and the world’s largest technology companies. He talks about how incumbents have an unfair advantage and a “right to win” because of their footprint with trusted clients, and how speed and nimbleness give startups an advantage. He says startups focusing on AI need to understand if they’re supercharging an existing process, or creating a truly new paradigm, because understanding this will dictate their path to success.
• Governance – Peter talks about the governance and regulatory issues impacting AI adoption and the potential for certifying technology for specific uses, similar to what’s required for pharmaceuticals or software as a medical device. He also discussed how Microsoft is building safeguards within its cloud infrastructure, allowing the ecosystem to stay focused on innovation.

To hear Keith and Peter talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders

Many physicians today choose to pivot their careers and apply their clinical knowledge to the innovation and digital transformation side of healthcare. Dr. Rasu Shrestha was an early pioneer of this trend and as he explains, went from “the dark side of radiology to the dork side of informatics” more than two decades ago.

In addition to spanning both technical and clinical roles, Dr. Shrestha brings a worldly view of medicine to his work as EVP and Chief Innovation and Commercialization Officer at Advocate Health. He attended college in Malaysia and medical school in India before becoming a visiting fellow in biomedical engineering at Imperial College London and a research fellow in informatics at the University of Southern California, where he also earned his MBA.

Among many other positions, Dr. Shrestha also served as Chief Innovation Officer at the University of Pittsburgh Medical Center, and Chief Strategy and Transformation Officer at Atrium Health. After the December 2022 merger of Atrium Health and Advocate Aurora Health, Dr. Shrestha landed in his current role at the newly formed Advocate Health, now one of the nation’s largest nonprofit health systems.

In an earlier Healthcare is Hard episode, Scott Powder provided his perspective on the megamerger from the Advocate Aurora side. In this episode, Keith Figlioli talked to Dr. Shrestha to hear his perspective from the Atrium side, and his thoughts on many of the biggest topics driving healthcare transformation. Some of the issue they discussed include:

• Financial realities in the post-pandemic era. With health systems facing some of their worst financial years ever and confronting an urgent need to transform in fundamental ways, Dr. Shrestha shares his ideas about how they can think differently. He says health systems should move beyond the idea of coopetition to the notion of strategic partnerships done right. He urges health systems to embrace the headwinds and tailwinds of the of the pandemic, while staying grounded in their mission and the reality that the old way of doing things will no longer work.
• Examining AI with a critical eye. There’s unprecedented excitement around artificial intelligence and generative language models like Chat GPT, but issues like hallucination bias raise serious concerns. As Dr. Shrestha explains, large language models do not really answer questions; they create responses that look like answers. These responses always sound authoritative, which means they always look right, even when they’re wrong. While these technologies will undoubtedly have a role in the future of healthcare, they must be carefully examined and regulated first.
•  Inoculating against the shiny object syndrome. Dr. Shrestha discusses how important it is to separate the hype from the hope in the era of AI and startups promising other breakthrough innovations. To remain grounded, he stays focused on three areas that he explains: moving from transactional to experiential, from a patient-centered to a person-centered approach, and from episodic care to always on 24/7 care.
• Realizing the benefits of scale. Despite a lot of M&A and market consolidation, Dr. Shrestha talks about how there hasn’t been much success yet realizing the benefits of scale. He shares his thoughts on strategies for driving those benefits and creating value at Advocate Health, and the role innovative startups can play in that journey.

To hear Keith and Dr. Shrestha talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Understanding healthcare spending growth in America is a critical component of any initiative attempting to improve care quality and affordability. This holds true for every person or organization focused on improving healthcare – from policy makers, to traditional healthcare incumbents, new entrants, and the entrepreneurs driving digital health innovation.

There are few people who understand healthcare economics in the U.S. as well as Michael Chernew, PhD, who has dedicated his career to studying healthcare spending and how it affects the quality of care and outcomes. Dr. Chernew is the Leonard D. Schaeffer Professor of Health Care Policy, and director of the Healthcare Markets and Regulation Lab in the Department of Health Care Policy at Harvard Medical School. Among many other roles, he is also currently serving as the Chair of the Medicare Payment Advisory Commission (MedPAC), an independent agency that advises Congress on costs, payments and other issues affecting the Medicare program.

Dr. Chernew’s research examines several areas related to improving the health care system including studies of novel benefit designs, Medicare Advantage, alternative payment models, low value care and the causes and consequences of rising health care spending.

In this episode of Healthcare is Hard, Dr. Chernew shares his knowledge with Keith Figlioli in a discussion that touches a broad range of topics around healthcare economics and innovation, including:

• The false choice between free markets and government intervention. While some people argue for a stronger government role in healthcare, others believe there needs to be better mechanisms to make markets work better. Dr. Chernew says we need to use the power of the markets where we can and sees a lot of potential for innovation to play a role. But he is also skeptical about how much markets can accomplish on their own. He says the most important thing is to recognize that both the government and the markets are flawed, and he talks about the need to understand where flaws exist in order to navigate them.
• The appetite for disruptive innovation. There are a lot of organizations now that believe they can deliver good population health for less and capture the gains associated with that efficiency. While the effectiveness of these new approaches generally remains to be seen, Dr. Chernew talks about how there are now many mechanisms in place that will allow organizations to accept risk, along with an appetite for innovation that has grown exponentially over the last decade – especially if it can lower spending.
• Skepticism on the impact of better primary care. There’s a common belief that more and better primary care will ultimately save money because everyone would be healthier. This might be true in some places or situations, but Dr. Chernew says he’s very skeptical of the assertion that it could scale in the current system. He explains how saving money is typically achieved by eliminating low value care and providing high value care more efficiently, and talks about potential alternatives for expanding primary care as it exists today.
• The high cost of drugs. There’s a lot of disfunction in the drug market in terms of pricing and value, and the way Dr. Chernew explains it, high costs are really financing future innovation. He says there are core debates about how much innovation should be financed, and how much innovation will occur as a result. He talks about options for designing potential structural changes and incentives to address these issues.

To hear Keith and Dr. Chernew talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Julie Barnes has made a career helping health plans, tech vendors, investors and others in the healthcare space decipher health policy. She’s a former Hill staffer who earned her law degree and spent a decade in corporate law serving healthcare clients before moving to policy think tanks, business consulting, and founding Maverick Health Policy. At Maverick, she provides strategic advice on federal health policy to private companies and industry coalitions, with particular focus on health data and value-based care.

With the U.S. presidential election less than two months away, Julie is kicking off a series of Healthcare is Hard episodes that will explore the implications of the shifting power structure in Washington. Next year, there will be a new administration and a new makeup of the U.S. Congress – that much is certain. How these changes will impact health policy and healthcare investing in public and private markets is a much bigger question. During the next few episodes, both before and after votes are cast in November, Keith Figlioli will shed light on these topics with an expert panel of guests.

A few of the topics Keith and Julie discussed during the first episode of this series include:

• The alphabet soup of healthcare policy. One of the things that surprises Julie’s clients the most is the myriad of federal agencies that play a role overseeing healthcare – from HHS and CMS, to the FDA, CDC, NIH, FTC, NIST and many others beyond the big, well known organizations. With Healthcare accounting for nearly one quarter of the federal budget, there is a massive public sector infrastructure behind it, which is a big reason why healthcare policy takes so much effort to navigate. Julie offers advice for organizations looking to better understand healthcare policy, and for the people driving it. For example, she says the wonks, lawyers and lobbyists all talk funny. She admits to being part of this group, and says they need to reduce the lingo for the sake of those not so intimately involved.
• AI changing everything. When discussing the modernization of the healthcare system, Julie talks about artificial intelligence (AI) being the main focus right now. She believes it has the potential to dramatically change everything because of the far-reaching impact it could have on areas ranging from workforce shortages to clinical decision support, user experiences for providers and patients, and more. She says healthcare AI policy can’t be written fast enough because of the speed with which the technology is developing, but there are many problems to navigate. One is that the public sector lacks experts who fundamentally understand this new technology, which will create challenges with ensuring that regulations are thoughtful enough to create a level of trust around AI without grinding innovation to a halt.
• White House hysteria. While the country is fixated and divided on an historical race for the Presidency and the impacts of the outcome, Julie is quick to point out that changes in healthcare policy will not be fast, and will not be sweeping. There are broad brush policy changes you can expect based on party philosophies, like Democrats being more skeptical about the influence of private money than Republicans. But major legislative changes require bipartisan effort, no matter who controls the White House, Senate, and/or House. But one major area where Julie thinks many people are underestimating the potential for change is the impact of the Supreme Court’s recent decision on the Chevron Doctrine. She talks about how this will open the floodgates on a wave of litigation.

To hear Julie and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

When Joel Vengco started his thesis during the third year of a MD-PhD program, it was the beginning of the end of his time in medical school. It changed his career path and kicked-off what he says is a love for data.

The field of Big Data didn’t exist yet, but it’s essentially where Joel was focused. And thanks to a professor who was also the chief scientific officer at Eclipsys (which later merged with Allscripts), Joel had access to extensive datasets to drive his work. He initially found a lot of data in disarray, but he also recognized the future potential for using data to transform the healthcare industry.

Joel eventually left medical school in favor of a career chasing healthcare data inside venerable provider and vendor organizations – from Eclipsys and GE Healthcare, to Boston Medical Center, Partners Healthcare, and Baystate Healthcare where he founded the digital health incubator, Techspring. Joel is currently SVP & Chief Information & Digital Officer at Connecticut’s most comprehensive healthcare network, Hartford Healthcare.

In this episode of Healthcare is Hard, Joel talks to Keith Figlioli about using data to drive healthcare transformation, his strategies for optimizing technology in a provider organization, and his advice for startups and entrepreneurs. Some of the topics they discuss include:

• Data liquidity. For people who work with big data, the “5 Vs” that guide success – volume, value, variety, velocity and veracity – are well known. But Joel says another attribute that’s missing and will be increasingly important is liquidity. He talks about how being able to move data from one place to another is essential for creating ecosystems. He talks about how analytic ecosystems, partnership ecosystems, and even startup ecosystems all require data to move freely.
• Data literacy. Through his various roles, Joel has seen significant differences in the way organizations use data to make decisions. He describes how some providers monitor data retrospectively, while others are using data more like a payer would, especially when those organizations share risk. He talks about a future where organizations understand data at a deeper level and use it to not just “admire the problem” with reports, but to help make the next decision.
• Technology through an equity lens. In many ways, technologists and developers are designing the future of healthcare. Joel talks about the responsibilities that come along with that, and how he instructs his team to look at everything they build, design and develop through an equity lens. He also discusses recent developments in artificial intelligence, such as ChatGPT, and the need for guardrails to ensure it’s used responsibly.
• Shifting right. To support the transformation of healthcare, Joel talks about how technology leaders in health systems must move beyond the traditional business of IT. He estimates that the average health system currently invests 90% of its resources on traditional IT work, and only 10% on transformative projects. He calls for a drastic shift and says organizations should get to a place where they’re spending 40% on traditional IT and 60% on transformation.

To hear Keith and Joel talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Advocate Health is the nation’s fifth largest nonprofit health system, operating 67 hospitals and more than 1,000 sites of care to generate revenues topping $27 billion.

This new entity was formed by combining two like-minded, not-for-profit health systems in December 2022: Midwest-based Advocate Aurora Health and Southeast-based Atrium Health.

While this was among the biggest mergers ever in the nonprofit healthcare ecosystem, it wasn’t the first for Scott Powder. In the early 1990s, Scott began working for Evangelical Health System, a pioneer of horizontal integration, which later became Advocate Health Care. Over the next 30+ years serving in various strategy and planning roles, including overseeing the 2018 merger of Advocate Health Care in Illinois and Aurora Health Care in Wisconsin, Scott had a front row seat to the growth and development of the healthcare ecosystem.

Scott is now President of Advocate Health Enterprises, where he is responsible for advancing Advocate Health’s whole person health strategy by investing in solutions that complement the health system’s core clinical offerings and broaden its business portfolio.

In this episode of Healthcare is Hard, Scott talks to Keith Figlioli about the strategy behind creating Advocate Health, and the market forces driving it. They discuss topics including:

• The shifting mindset on geography. One of the most unique things about the new Advocate Health is its geographic footprint. While Illinois and Wisconsin are neighboring states, the company now also serves communities much further away in North Carolina, South Carolina, Georgia and Alabama through the merger with Atrium. Scott talks about the traditional mentality that all healthcare is local and how he doesn’t believe that is the case anymore. He discusses the role geography still plays in high acuity care, and how technology is enabling so many more elements of healthcare to be delivered practically anywhere. 
• The debate over scale. There’s concern in the market about some health systems becoming too big, and a debate about whether or not these organizations are truly optimizing the value of their scale – or if they ever will.   But Scott points out how scale is relative, especially in a fast-evolving healthcare market. For example, he raises the point that even if the five largest nonprofit health systems in the country were combined, they would still only generate half the revenue of a company like CVS Health or United Health Group, and only a fraction of the revenue of players like Amazon. He also talks about ways health systems can create scale outside of traditional M&A, such as joining forces around issue-specific consortiums.
• Dual transformation. Scott compares the difficult decisions facing healthcare to other industries like automotive, where companies have made commitments to move away from the core of their business – the internal combustion engine – in favor of investing in electric vehicles of the future. He talks about the capital-intensive demands of operating a core clinical care delivery business, and how challenging it is to divert money from those operations to invest in other areas. But he says it’s the only way incumbent health systems will survive.
• Care in the home. A lot of Scott’s focus at Advocate Health Enterprises is around a thesis that a person’s home will be a center for care delivery in the future. He believes there will always be a need for hospitals, but that they’ll look very different in the future, and he talks about acquisitions Advocate has made to marry personal care, clinical care and technology in the home.

To hear Keith and Scott talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

The digital transformation of healthcare has been a long and winding road, but one that is starting to open new possibilities in every aspect of business operations, care delivery and consumer experiences. The critical aspect to all of this is a newfound access to data.

Dale Sanders and Ryan Howells have been at the forefront of the movement to unlock data in healthcare and help organization leverage it to actually drive business and clinical performance. As Principal at Leavitt Partners, Ryan works with the White House, Congress, HHS, and VHA on health care policy and interoperability issues. He also currently leads the CARIN Alliance, a multi-sector, public-private alliance focused on giving consumers digital access to their health information. Dale is Chief Strategy officer at Intelligent Medical Objects (IMO) where he closely analyzes market needs and challenges to set IMO’s strategic direction developing products that deliver critical data quality improvements and insights to improve patient care.

In this episode of Healthcare is Hard, Keith Figlioli draws on the decades of experience Dale and Ryan have driving healthcare data policy and strategy. Their discussion touches on the intricate details of healthcare data, the everyday impacts that data can have on healthcare consumers, and many points in between. They cover topics including:

• Entering the “app economy” for healthcare. Ryan points out that almost every other aspect of the consumer world entered the app economy almost 20 years ago. But for healthcare, that transition is just starting. They talk about how the emergence of structured data eliminates the need to rely solely on legacy vendors to solve problems, and the potential it unlocks for creating new, billion dollar companies.
• Encouraging physicians to stage a riot. The group discusses how quality measures are creating administrative overhead, burning-out physicians, and affecting data quality in ways that many people don’t realize. With revenue streams that are tied to these outdated processes and make them difficult to change, a shift towards measuring outcomes will not be easy. What will it take? Dale says one option he’s encouraging is an uprising among physicians.
• The B-to-C-to-B data strategy. Data privacy has been a big hurdle to enabling the exchange of EHR data and patient information between organizations. But what if patients have full control of their data and can be the conduit between providers and other organizations? Ryan talks about how this can fundamentally change the issue of data portability by eliminating the need to negotiate and implement complex legal agreements required to exchange data between two organizations. They talk about how this strategy hinges on the ability to verify digital identities.
• Disrupting EHR incumbents. With so much change on the horizon and data access creating new possibilities for healthcare’s core infrastructure, should incumbent EHR vendors be nervous? Dale says a new enterprise infrastructure in healthcare – a next-gen EHR that’s focused on team-based care, not the encounter – is imperative. And he offers advice on how to get there. Ryan adds his belief that the industry needs a complete new coding system built for value-based care, not fee for service.

To hear Keith, Dale and Ryan talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

As the world emerges from the pandemic and U.S. health systems navigate a unique set of challenges they’ve never faced before, they’re fighting a battle on two fronts. They don’t have the luxury of dedicating all their resources towards the significant challenges they’re facing today. They also have to stay focused on innovation that will drive future growth, while finding the right balance between these priorities.

Health systems can’t make these critical decisions in a vacuum – that’s why the information and expertise they get from Sg2, a Vizient company, is critical. As the nation's largest health care performance improvement company, Vizient serves more than 60% of acute care providers. Sg2 provides these organizations with unparalleled insight into local market dynamics and helps them anticipate healthcare trends that will be key to their success.

John Becker leads Vizient’s Strategic Growth Solutions, including Sg2’s Intelligence, Analytics and Advisory Services, and the Vizient Research Institute. In this episode of Healthcare is Hard, John talks to Keith Figlioli about the issues that are top of mind for health system strategy and innovation leaders. They discuss topics including:

• Post-Covid collaboration. While the pandemic created extremely difficult conditions that persist today for providers, John sees a bright spot in how it taught their leadership teams to work together in different ways. As an example, he talks about how Sg2’s work extends more regularly beyond strategy teams and how those in other leadership roles are thinking differently about the future and their approach to competition.
• Innovating in a down market. John talks about the need to cut costs due to margin pressures, and the challenge health systems now face making sure they don’t cut areas that will drive future growth. He says he’s starting to see bifurcation in the market where strategy teams are splitting in two. One team is focusing on traditional care delivery and “same store growth,” while the other team works on reimagining the business altogether.
• The upside and downside of scale. As many health systems converge to drive efficiency through scale, diversification can help larger systems navigate difficult times. However as John points out, bigger ships can weather bigger storms, but it takes them much longer to turn. He says the key is centralizing certain functions and realizing that strategy deployment needs to incorporate the nuances of local markets where things like payer mix, employee base and demographics make a big difference.
• The CFO’s role in innovation. John says the most successful health systems right now are all finding the right balance around resource allocation, and he points out how the CFO is critical in achieving this. He says those that are too focused on costs are going to miss growth opportunities, and those that are focused too heavily on transformation will have trouble with operations. Carving out dollars to reimagine the business, while funding the core business at the appropriate level is a delicate balance, and one that savvy leadership teams are finding.

To hear Keith and John talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

It’s a difficult time for health systems who are struggling with financial pressures brought on by rising costs, patient volumes that continue to remain below pre-pandemic levels, and a host of other issues putting their balance sheets in the red. But at the same time, the need for innovation has never been greater. New technology will be essential to streamline operations and meet consumer demand for new care delivery models while staying ahead of big tech, retailers and others adding pressure for providers to evolve and transform.

How can providers focus on getting business fundamentals back in order, while also looking to the future and accelerating their focus on innovation?

On this episode of Healthcare is Hard, Sara Vaezy, chief strategy and digital officer at Providence, talked to Keith Figlioli about the need to address both of these issues at once – and how to do it. Some of the topics they cover include:

• New economics for providers. While there may have been an initial hope about getting through the pandemic and getting “back to normal,” it’s now clear that the fundamental economics of healthcare – especially for providers – will never be the same. Sara says the industry is starting to get comfortable with the notion that provider economics have eroded in a long lasting way. Recognizing this fact and finding new ways to diversify will be essential for providers to thrive.
• Building beyond acute care. Health systems are being forced to choose if they want to focus on being the center of acute care in their communities and be part of a larger network of services, or broaden beyond that to provide more elements of the network themselves. Sara says not every hospital or health system has the resources to expand on their own, but sees Providence on a path to becoming a “health company with a care delivery arm.” She talked about how this model could even give providers national scale, as opposed to operating within a geographic footprint.
• The importance of partners. Innovation is essential for every health system in one way or another, and Sara admits that it’s hard to do on your own. Those who cannot drive meaningful innovation themselves will be forced to consolidate or partner with others. Those who can and have been driving innovation will continue to do so, but Sara predicts that even they will form more innovation consortia and financing partnerships to focus on key areas where reach and scale will create a more efficient cost structure for innovation. This will also create more opportunities for entrepreneurs to work directly for or with health systems.
• The advantage of incumbents. It’s easy to be critical of healthcare incumbents, but Sara points out how important it is to not forget that they still deliver the vast amount of care at scale in the U.S. This is a significant advantage that can be amplified even more when incumbents work together. As she says several times, it’s difficult to drive innovation and the transformation of healthcare alone. Collaboration will be critical.

To hear Keith and Sara talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Tim Kosiba was first exposed to the healthcare industry while working at the FBI in the 1990s as part of its Computer Analysis Response Team (CART). For more than 30 years, he worked at the highest levels of government driving the cybersecurity, digital intelligence and offensive cyber practices that keep the country’s critical infrastructure safe.

Tim started his career in the Navy, working for the organization now known as the Naval Criminal Investigative Service (NCIS), where he was successfully investigating digital crimes before the field of computer forensics was even established. In this role, he collaborated frequently with, and was soon asked to join the FBI, which was building its Computer Analysis Response Team (CART) to pioneer processes for investigating computer crimes and examining digital evidence.

At the FBI, Tim worked closely with the National Security Agency, until he was asked to join the NSA directly. After more than a decade serving both domestically and abroad, Tim left NSA and joined the private sector to help advance the collaboration between public and private organizations on national cybersecurity interests.

Tim now works closely with the American Hospital Association and healthcare organizations across the country as CEO at bracket f, a wholly owned subsidiary of [redacted]. And yes, “[redacted]” is the company’s name – it’s a startup built by a team of cybersecurity veterans with resumes that rival Tim’s. The company is focused on leveling the playing field by identifying and stopping threats, legally pursuing attackers, and bringing cybercriminals to justice.

In this episode of Healthcare is Hard, Tim shares some of his insider knowledge with Keith Figlioli on topics of growing urgency for everyone in the healthcare industry – from providers, payers and life science companies, to the innovative startups transforming healthcare. Issues they discuss include:

• The state of healthcare cybersecurity. Tim says the healthcare industry has a lot of catching up to do. Unlike other industries, where security has always been part of the equation, the fact that security was not a primary concern when digitizing medical institutions has put healthcare behind. While he says things will get worse before they get better, Tim is optimistic for the future and sees positive activity like increased public/private partnerships. For example, he cites efforts to declassify more information and share it in a way that doesn’t divulge sources and methods so the industry can use it to be better prepared.
• Who’s attacking healthcare and why. The trend is very specific, according to Tim. He says it’s primarily state sponsored groups, often based in Russia. Some groups are directly sponsored by the state, while others are simply allowed to operate with impunity. The motivation is usually cash or chaos. After all, healthcare is part of a nation’s critical infrastructure and disrupting it can cause havoc and hardship, compromise intellectual property and much more.
• Implementing the basics. Tim recognizes the challenges healthcare faces balancing security with the demand for better consumer experiences. But he points out that many hospitals he works with don’t have cyber security basics in place, like incident response plans, penetration testing or two-factor authentication. He says there’s a knowledge problem, but it’s something that can’t be addressed until the industry accepts the cost of cybersecurity. As cyber insurance becomes hard to get and insurers mandate procedures like two-factor authentication, he says it may cause the tipping point we need.

To hear Keith and Tim talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Marcus Osborne started his professional life as a White House intern and never intended to pursue a career in healthcare. In fact, he says he has a phobia of needles and doesn’t find much pleasure in daily work dealing with issues like insurance and disease. But he says healthcare kept finding him, and he admits that no other sector has more need for good, talented people trying their best to make progress.

After a couple jobs in business consulting and time as Chief Financial Officer for the Clinton Foundation’s Health Access Initiative, Marcus landed at Walmart, where he ultimately became Senior Vice President of Healthcare Transformation. In January 2022, he stepped down from that role after spending 15 years at the world’s largest retailer driving key initiatives to increase healthcare access and affordability, including helping to launch Walmart Health and leading Walmart Health clinics.

In this episode of Healthcare is Hard, Keith Figlioli taps into the knowledge and experience Marcus has gained through his career to explore issues including: 

• Viewing healthcare through the consumer’s eyes. Looking back on his time at Walmart, Marcus says it was the best place to work on transforming healthcare since it is fundamentally a consumer company. But he also says it was sometimes the worst place given all the other competing priorities outside of healthcare at such a large organization. Marcus credits some of his biggest successes to one simple idea – that consumers are very clear about what they want, and what their challenges are. You just have to listen, and deliver.
• Retailer acquisitions. In addition to shedding light on the inner workings of Walmart and its ambitions to grow in the healthcare market, Marcus talks about the moves other retailers, including Amazon and CVS, are making through acquisitions. He views Amazon’s acquisition of One Medical as a Brilliant move that gives the company excellent operating talent around primary care, a physical presence to continue building the omnichannel healthcare experience, and strong value-based care components through One Medical’s earlier acquisition of Iora Health. He says the strategy is a home run, and talks about how it now comes down to integrating and execution.
• The future for health systems. Marcus and Keith talk about the idea of a health system as a community integrator. Instead of owning assets, they ponder the benefits for health systems that get better at partnering with outside organizations in deeper, more collaborative ways. For example, as the industry moves towards value-based care beyond Medicare, Marcus sees a big opportunity for health systems to create more efficiencies by being the community integrator around specialty practices in areas such as cardiology, maternity or musculosketal health.
• The opportunities for entrepreneurs: The great news for entrepreneurs, according to Marcus, is that the big players are far from figuring everything out. He compares the current state of healthcare innovation to the Internet in the 1990s where there was a tremendous amount of innovation and companies were focused on developing the best point solutions. For example, there were dozens of search engines, from Yahoo, to Google, Excite, Alta Vista, Ask Jeeves and many more. But Google ultimately emerged to unify the back end of search for everyone. Today in healthcare, Marcus points out how it’s becoming harder for consumers to learn how to deal with all the individual solutions in the market, and says they’re starting to look for someone to integrate everything for them.

To hear Keith and Marcus talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Dr. Julian Harris developed a personal passion for home health and shifting care towards value watching his father and his grandfather serve as caregivers for his mother and grandmother, who both had complex health conditions. He started his professional life as a primary care doctor in community health centers and safety net hospitals, but with an interest in business, gravitated towards a career that has spanned the highest levels of provider, payer, government and many other organizations. He is now applying his knowledge and experience towards his passion for care at home, serving as chairman and CEO at ConcertoCare, a value-based provider of at-home, comprehensive care for seniors and other adults with unmet health and social needs.

In addition to his role leading ConcertoCare, Dr. Harris is also an operating partner at the healthcare investment firm, Deerfield Management, and earlier in his career served as an advisor to Google Ventures (GV). He also led the healthcare team in the White House Office of Management and Budget (OMB) and before that, served as the chief executive for the Massachusetts Medicaid program. Most recently, before joining Deerfield, Dr. Harris worked at Cigna, where he led U.S. Strategic Operations and internal investment in technology and innovation, and then served as President of CareAllies, a group of Cigna-affiliated population health management and home-based primary care companies.

In this episode of Healthcare is Hard, Keith Figlioli’s conversation with Dr. Harris covers a wide array of topics related to healthcare innovation and new care delivery, including:

• The levers of shifting care towards value. Drawing on his perspectives from clinical, innovation and policy roles (at both the federal and state level), Dr. Harris describes how he thinks about the different levers that can be adjusted to improve quality while ensuring that healthcare is affordable. He talks about the main goal of incentivizing providers to practice evidence-based medicine and adjusting key levers including the number of people covered, level of benefits, negotiated rates with providers, and utilization, and how they all impact each other.
• The VBC journey for each category of home care. Dr. Harris discusses the broad range of services delivered in the home – from PT and OT, to infusion services, palliative care, hospice, and even home-based primary care. He talks about how organizations focused on individual components of home care are finding their way towards value, how Medicare and Medicaid are driving the movement, and the end goal of combining all the pieces for comprehensive care.
• Thoughtful acceleration of digital tools. While there are many barriers for aging patients to engage with digital tools, Dr. Harris is seeing thoughtful and effective execution by companies addressing issues like remote patient monitoring, medication adherence, and chronic condition management. He sees the most success with patients utilizing these tools in an integrated model and talks about the increasing role digital tools will naturally play as people engage more as they age, or before they develop complex health conditions.

To hear Dr. Harris and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

As a self-described latchkey kid growing up in Los Angeles, Dr. John Halamka says riding his bike to Raytheon, Hughes Aircraft and Aerojet – and pulling integrated circuits and manuals from their dumpsters to learn how they worked – lured him into the world of technology. Not long after, he started developing his first healthcare-related IT system, which he sold to UCLA when he was 14.

Those experiences kicked-off a career where Dr. Halamka has worked at the intersection of technology and healthcare for five decades. Trained in emergency medicine and medical informatics, Dr. Halamka has served in many roles, including chief information officer at Beth Israel Deaconess Medical Center for more than 20 years, where he oversaw digital health relationships with industry, academia, and governments worldwide. As the International Healthcare Innovation Professor at Harvard Medical School, Dr. Halamka helped the George W. Bush administration, Obama administration, and governments around the world plan their health care information strategies.

In his current role as president of the Mayo Clinic Platform, Dr. Halamka leads a portfolio of platform businesses focused on transforming health care by leveraging artificial intelligence, connected health care devices and a network of trusted partners.

In this episode of Healthcare is Hard, Dr. Halamka shares his perspective on the evolution of digital health and where the industry is headed through an in-depth conversation with Keith Figlioli. The topics they cover include:

• Mayo’s platform play. As president of the Mayo Clinic Platform, Dr. Halamka spends time explaining the organization’s view about what constitutes a platform and why it’s important. He describes it as an ecosystem that’s built to foster innovation at an extraordinarily fast pace. He contrasts the approach to other healthcare organizations where building collaboration is hard, and discusses how the Mayo Clinic Platform makes it easy for innovators to find mentors, access millions of de-identified patient records to test new technology, tap into thousands of clinical experts to address a problem, and so much more.
• The arc of healthcare IT. Dr. Halamka explains innovation in digital health – especially through the implementation of Meaningful Use over the past decade – with a quote from Winston Churchill: “Americans will always do the right thing. After they’ve tried everything else.” While it took a long time to arrive, he does not lament the journey and expresses optimism for the current state and future of digital health.
• Guardrails for AI and ML. Much like Google Cloud’s Aashima Gupta described in a past Healthcare is Hard episode, Dr. Halamka talks about the need for a standard set of metrics to measure the performance of AI models in healthcare. He views his career as seven or eight distinct periods of achievement including events like standardizing vocabularies or moving to APIs, and believes the next period will be about creating the guidelines, guardrails and transparency for machine learning in healthcare, and using it ubiquitously across the globe. 
• Convergence of AI and ML models. Dr. Halamka says he is seeing an amazing array of startup activity creating models for niche purposes on multimodal data. He says there will be a huge number of model providers and talks about the importance of platform players being able to bring them together. He says data liquidity and a huge ecosystem of players coming together will be revolutionary in the ability for people to navigate their health care.

To hear Dr. Halamka and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

At the beginning of the pandemic when nursing homes were a hotbed for COVID-19 infections and many untimely deaths, the Institute for Healthcare Improvement (IHI) began hosting daily phone calls where hundreds of facilities joined to quickly get and share information that would improve their response. It led to a larger project over the next year that included every nursing home in the country sharing knowledge and information, and is an excellent example of how IHI achieves its mission of helping to improve quality and outcomes by learning and teaching best practices.

IHI was founded more than 30 years ago to improve the safety and quality of healthcare by studying how leading companies in other industries systematize processes to apply learnings across the healthcare ecosystem. Don Berwick, IHI’s founder, and Maureen Bisognano, president emerita, talked about the genesis of the organization as guests on the Healthcare is Hard podcast in February 2019. Since July 2020, the organization has been led by our guest for this episode: IHI’s current president and CEO, Dr. Kedar Mate.

In this episode, Dr. Mate talked to Keith Figlioli about his background as an Indian-American and how time spent in his youth traveling between both countries helped drive him towards a career dedicated to addressing health related injustice and inequities. They discuss many facets of the work he’s doing at IHI including:

• Questioning IHI’s relevance. After three decades of measurable success working towards its mission, one of Dr. Mate’s first decisions as IHI’s new CEO was to audit the organization and its relevance in a rapidly-evolving healthcare landscape. He describes three core value propositions – the organization’s methods, ability to inspire, and quest for driving results at scale – and how they apply today.
• Teaching – and learning – globally. With so many challenges around quality, outcomes and costs to overcome in the U.S. healthcare system alone, Dr. Mate talks about why IHI has chosen a broader, global focus. Much like the organization’s mission of bringing knowledge from other industries into healthcare, its involvement in healthcare delivery around the world enables it to identify and share strategies that are working across healthcare economies. 
• Measuring outcomes vs. process. Dr. Mate shares his belief about the current flaws in measuring care quality. He talks about how outcome-based measurement is underrepresented in favor of process-based measurement, and how the industry has a tendency to continue creating new measures without sunsetting old ones. He also shares the important reminder that measurement itself is not the objective, and that we must not lose sight of giving organizations tools and methods so they can actually change their measures and create better results.
• Quality and new care delivery. With new sites of care and options for virtual care continuing to grow, Dr. Mate and Keith talk about the role quality measurements will plan in the future of healthcare. They discuss the imperative for setting standards and measurements for virtual care and technology-enabled services, and how quality can become the major differentiator when there are no limitations on geographic boundaries.

To hear Dr. Mate and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

OSF HealthCare stands as a model health system for those who want to do innovation right. One of the defining characteristics of the Peoria, Illinois-based system is how it aligns innovation with operations for everyone – all 24,000 employees across 159 locations, including 16 hospitals.

Becky Buchen is responsible for driving innovation at OSF HealthCare. As SVP of Innovation Operations she works to engage and educate people on the innovation process, leveraging the eco-system for innovation built at OSF, including simulation, analytics, OSF Ventures, Innovation Studio, Digital Innovation Development and Performance Improvement.

Becky’s background in performance improvement has been a major influence in OSF HealthCare’s approach to innovation. Prior to her role leading innovation, she served as VP of Performance Improvement where she focused on implementing methodologies to monitor, assess and improve patient experience, patient outcomes, and overall operations.

In this episode of Healthcare is Hard, Becky talked to Keith Figlioli about how OSF HealthCare formalized its vision for innovation more than a decade ago and the thoughtful approach to ensuring that it would be fully integrated – not simply a “bolt on.” The goal was to truly make an impact and transform how care was delivered across the organization, and to do so, OSF HealthCare recognized that it had to apply the same level of rigor for exploring, testing and measuring innovation initiatives as it historically had to performance improvement.

In her conversation with Keith, Becky discussed specifics about OSF HealthCare’s approach to innovation that both digital health entrepreneurs and other health systems can learn from. Some of the topics they discussed include:

• Integrating innovation into culture. Perhaps the most visible example of OSF HealthCare’s commitment to integrating innovation into every aspect of its operations is the physical footprint. At its main campus, OSF HealthCare has an entire building dedicated to innovation, including two floors built for simulation, allowing clinicians to test and understand new approaches in a safe space, two floors housing its healthcare analytics division, and much more.
• What health systems are getting wrong (and right). To approach innovation successfully, Becky says health systems need to first have a fundamental understanding of the problems they’re trying to solve. She warned of dedicating resources towards solutions that are looking for problems. OSF HealthCare learned to avoid this trap early, but Becky says it’s still an area of caution for some systems. She talked about how critical it is to pick problems that are big enough to make a significant impact when they’re solved in new and different ways.
• Retooling and reskilling due to artificial intelligence. Becky talked about the healthcare industry being “data rich and information poor,” and described efforts to centralize data and improve data quality as a critical step to driving value from innovation. While tools like those being explored with generative AI will ultimately allow healthcare organizations to operate more efficiently, data quality and proper governance are essential to establish first. And after that, healthcare organizations should be thinking about how they will need to retool and retrain frontline operators and clinicians.

To hear Becky and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Dr. Meena Seshamani is responsible for the health care coverage of more than 63 million Americans and nearly one in every five healthcare dollars spent in the U.S. With the ultimate goal of keeping the people who rely on Medicare at the center of every decision, her role as the director of  the Center for Medicare at the Centers for Medicare & Medicaid Services (CMS) requires her to balance the personal side of healthcare with the complexities of the healthcare system at large. And she has a rare combination of qualifications that give her a profound expertise with both.

As an ear, nose and throat surgeon, Dr. Seshamani has worked at leading health systems delivering care at the patient bedside and serving in senior executive leadership roles. As a PhD in healthcare economics, she has decades of healthcare policy experience. She recently served on the leadership of the Biden Administration’s transition team at the Department of Health and Human Services and was previously director of the Office of Health Reform where she drove strategy and led implementation of the Affordable Care Act across the department.

This diverse background as a health care executive, health economist, physician and health policy expert gives her a unique perspective on how health policy impacts the real lives of patients.

In this episode of Healthcare is Hard, Dr. Seshamani spoke to Keith Figlioli about her expansive role and her focus on the key pillars at Medicare: advancing health equity, driving innovation in healthcare, maintaining good fiscal stewardship and delivering high-quality, person-centered care. Their conversation covers several topics including:

• A day in the life of CMS. While every day is different, one recurring theme Dr. Seshamani discusses throughout the interview is the importance of listening to patients, staff, partners and others. She says her education and experiences have given her the humility to understand that no one person knows everything and that listening to all stakeholders is a critical component to realizing the power Medicare has to positively impact healthcare in America.
• Pieces of the Medicare puzzle. Medicare Advantage plans continue to grow in popularity and now account for more than 40% of Medicare enrollees. And while that means more people are transitioning away from traditional Medicare, Dr. Seshamani shares her thoughts about the continued importance of every piece of the Medicare program. The main objective is providing people with options so they can find the solution that works best for them which in turn, drives the system towards achieving the vision of greater health equity.
• Helping people navigate Medicare. With so many options in the Medicare program, especially with the proliferation of Medicare Advantage, it creates challenges to help seniors navigate them all. But Dr, Seshamani looks at that challenge and sees it as an opportunity. She talks about ways to provide people with the data and information they need to make decisions and the changes CMS is making to the Plan Finder to make that process easier. She also talks about adding additional oversight over third-party marketing for Medicare Advantage based on direct feedback she received about the confusion it can cause for seniors nationwide.

To hear Meena and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Aashima Gupta was a rising star in the financial technology world at organizations including Fidelity Investments and JPMorgan Chase, but after her father passed away suddenly due to health reasons, she turned her technical talents towards improving healthcare. After five years in leading technical roles at Kaiser Permante and two years leading healthcare strategy at the API and analytics company Apigee, she became director of global healthcare solutions at Google Cloud through its acquisition of Apigee. 

While historically big tech has had little insight into what is happening on the ground within vertical markets – including healthcare – that paradigm is shifting. As part of this evolution, cloud infrastructure companies are tailoring solutions to meet specific needs and advance digital transformation within industries like healthcare. This is the crux of Aashima’s role at Google Cloud where she focuses on applying Google Cloud technology, machine learning, artificial intelligence, mobile and APIs to help companies in the healthcare ecosystem identify new care models, improve patient experiences, generate new revenue streams and securely share data.

In this episode of Healthcare is Hard, Aashima talks to Keith Figlioli about her journey from Fintech to Digital Health and shares insight into Google’s strategy to transform healthcare. Topics they discuss include:

• The pace of innovation in digital health. Aashima recounts her transition to healthcare and the biggest differences with the pace of innovation. She had often dealt with mission critical systems in past roles at some of the world’s largest financial services organizations, but recognized quickly after moving to Kaiser Permanente that she was now dealing with life critical systems. She talks about the shifts in culture and mindset that a career in healthcare technology requires.
• Google’s most recent healthcare news. Google’s core mission is to democratize access to information, and its recent announcements about integrating features for scheduling medical appointments directly into search results shows how that mission extends to healthcare. These new features aim to address one of the most significant barriers to getting care: the ability to find an appointment. Aashima discusses how these new developments fit into Google’s larger vision for healthcare innovation and the company’s ongoing efforts to expand partnerships with third parties.
• Democratizing AI in healthcare. As a platform that fills a critical infrastructure role for organizations across the healthcare ecosystem – from payers and providers, to life science companies, tech vendors and more – Google Cloud places an intense focus on empowering these companies through advanced technologies like AI. With years of experience building, deploying and maintaining machine learning for its own use and incorporating that institutional knowledge into its cloud platform, Google is helping to democratize AI and accelerate healthcare innovation. As an example, Aashima points to customers that can train AI models using 80% fewer lines of code than they would need otherwise.
• Responsible use of AI. Google recognizes the power of AI and the equally powerful questions it raises about using it responsibly – especially in healthcare. Aashima shares how Alphabet CEO, Sundar Pichai, has been directly involved with the company’s principles for responsible AI innovation. She talks about how the company uses tools like “model cards,” which describe AI algorithms in a similar way to nutrition labels on food packaging, and how it’s pushing for these to play a foundational role in the future of AI.

To hear Aashima and Keith talk about these topics and more, listen to the full episode of Healthcare is Hard: A Podcast for Insiders.  

Dr. Mona Siddiqui says she loves solving problems at the intersection of health policy, strategy, data and operations. After earning a medical degree from Johns Hopkins, a master’s in public health with a focus on quantitative methods and data analysis from Harvard, and a master’s in engineering from Stanford, Mona has dedicated her career towards using this unique skillset to improve healthcare.

She served as a resident at George Washington University Hospital, Innovator-in-Residence at CMMI, and a member of the White House National Science and Technology Council, among other prominent roles. She also became the first ever Chief Data Officer at the Department of Health and Human Services where she led the effort to connect the nation's health care data through a new technology infrastructure, organizational management of data as an asset, and an enterprise training program for data science and AI. In her current role as SVP of enterprise clinical strategy and quality at Humana, she’s applying the vast knowledge and experience she’s gained towards one main objective: creating a better consumer experience in healthcare.

During her conversation with Keith Figlioli on this episode of Healthcare is Hard, Mona shared her thoughts on several timely topics including:

• The critical, yet unglamorous work of organizing data. Mona recounts how she experienced the pain of not having access to the right information at the right time throughout her career and in her initial role at HHS where she was tasked with thinking about new solutions in the opioid epidemic. She and her team realized the enormous amount of disconnected data at other government organizations such as the Department of Justice and the Department of Labor, and began integrating it to develop a new and unique lens into the challenges they faced. She talks about how infrastructure issues like this are not glamorous, but create incredible opportunities to make a meaningful and lasting impact.
• Humana’s evolution into a healthcare company. Over the past few years, Humana has forged partnerships with providers like Oak Street and Iora Health, acquired organizations including Kindred, the nation’s largest provider of at-home healthcare services, and grown many other new initiatives organically. As its track record demonstrates, Humana is considering all options in its transition to a “payvider” and remaining focused on the key objective of creating better consumer experiences and improving healthcare outcomes. Mona discusses how this long-term evolution is still in progress, while notably referring to Humana now as a “healthcare company.”
• Connecting in-person and digital experiences. With the digital transformation of healthcare, and especially advancements made over the past two years, technology is now an inherent part of consumer experiences in healthcare. Mona remembers her time as a clinician and how she often didn’t have the right infrastructure to give patients the support they needed. She talks about how Humana is in a unique position to think about a holistic set of experiences – not just for patients, put for providers too – and how to create them.
• Partnering with early-stage companies. For startups looking to make a difference in healthcare, Mona discusses what Humana is looking for in its partnerships and how to best work together. In clinical areas, she advises that Humana’s largest focus is addressing the needs of the sickest people. She also points to the need for solutions that bring caregivers and families into the conversation, and those that create integrated experiences in home and community-based settings. Overall, the goal is to become more efficient at providing the right care at the right time.

To hear Mona and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Phoebe Yang holds one of the most instrumental roles at the intersection of tech and healthcare. As general manager for healthcare at Amazon Web Services, she leads a team focused on making healthcare better by enabling organizations to increase the pace of innovation, unlock the potential of health data, and develop more personalized approaches to therapeutic development and care.

Phoebe also has a long history advising health systems at the board level. She previously sat on the board of Providence-St. Joseph Health and two ACO boards while in the C-suite at Ascension; and she is currently a member of the board at CommonSpirit Health, where she helps guide the $35 billion health system that has more than 700 care sites and 150,000 employees across 21 states. Phoebe also served as Chief Strategy Officer for Population Health at Ascension.

Over the course of three decades, Phoebe’s career has spanned multiple industries and sectors from law and government – where she served two presidential administrations in technology and international diplomacy – to media, healthcare and technology. All that experience has driven her to a place where digital transformation in healthcare has become a central focus of her career.

In this episode of Healthcare is Hard, Phoebe talks to Keith Figlioli about board dynamics in healthcare, while also sharing insight into her role at Amazon Web Services and her advice about how health systems should collaborate with tech companies. The topics they discuss include:

• Reshaping health system boards. Not long ago, board seats were largely occupied by health system insiders and other regional business owners in the communities an institution served. But now, a whole new set of competencies and perspectives is required, and among them, technology experience is a must have. Phoebe explains how it’s the board’s job to “look around corners,” anticipate every scenario and ensure the organization is thinking strategically in order to ensure near, mid and long term success. Without technology expertise at the board level, she says health systems will be disadvantaged in their efforts to engage patients and consumers as everyone’s digital lives expand.
• Two-way doors driving decisions. Phoebe believes the most mis-understood calculation in healthcare involves the notion of risk. She points out that everything in healthcare has traditionally been seen as a binary calculation of life and death, and shares an alternative strategy used by leaders at Amazon Web Services. She says they often look at whether decisions are a one-way door – one you can’t walk back through – or a two-way door. She says most decisions, even in healthcare, are two-way doors where you don’t need 100% of the information in order to make a decision. Acting on the information you have is better than being paralyzed and inactive. If something doesn’t work out, you pivot and adapt.
• Dealing with outside disruptors. From her role inside one of the biggest tech companies, Phoebe has sage advice for health systems. She says to remember that you are in the prime position and have spent decades building trusted relationships with your patients and communities. Remember that the biggest asset in healthcare is trust and think about how to use the trust you’ve built to better serve your customers. Most importantly, don’t obsess over what everyone else is doing because they would love to be in your position. What you should obsess over is your customers: it’s how Amazon Web Services operates and Phoebe says how health systems should too.

To hear Phoebe and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Since the beginning of the pandemic, Dan Michelson has held at least three to five zoom calls per day with hospital CFOs across the country. As the industry navigated the most disruptive and uncertain times in modern history, healthcare leaders turned to Dan for his insight and advice because of the unparalleled visibility he has into the market through his company, Strata Decision Technology. Strata provides financial planning and analytics software for more than 400 health systems and 2,000 hospitals – in other words, about half the U.S. healthcare provider market.

While health leaders turn to Dan on an ongoing basis, he’s also become known for articles every January that analyze the top trends and topics discussed at the annual J.P. Morgan Healthcare Conference. In fact this year, Dan published two articles – one in Fortune and one in STAT News – and for the third year running, joined Keith Figlioli to dive even deeper with a discussion on the Healthcare is Hard podcast.

What surprised both Dan and Keith the most at this year’s event is the fact that COVID was not really a focus. CEOs and CFOs from some of the nation’s most prominent health systems that presented during JPM’s non-profit track barely mentioned it because it’s now become a normal part of every health system’s operating model. COVID is no longer a specific focus because it’s an intrinsic element in everything they do, and they’re prepared for it.

But Dan’s articles touched on some of the other major topics from JPM that he and Keith talk about in this episode, including:

• Staffing. Staffing. Staffing. The headline of Dan’s article in STAT News captured the mood best: “Covid-19 is no longer the biggest issue facing hospitals. Staffing is.” Workforce issues dominated JPM this year and most presenters recognized these issues as their biggest focus and challenge. Dan and Keith discussed how health systems are thinking about staffing differently and how they’re thinking about deploying technology differently to ease staffing demands and burnout. They also discussed some of the new challenges providers are facing as the market evolves – such as competition for new talent from virtual care companies, specialty providers, payers and many others – and new strategies for training, recruiting and retention a result.
• Top strategies for the future. With COVID becoming a normal part of operations, health systems are finally thinking about the future again with a clear eye towards strategy. In Dan’s Fortune piece, “The greatest comeback in the history of health care,” he talked about the severe financial strains health systems faced over the past two years, with volumes down 30% to 40% in the early days of the pandemic. But now that the industry has weathered the storm and proven how critical and resilient it is, the focus is the future. From what Dan heard at JPM, he sees strategies falling into five critical areas that he and Keith discussed: M&A, investing in innovation, value-based care, creating destination centers, and deploying virtual care platforms.

To hear Dan and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Bryony Winn is a Zimbabwe native and Rhodes Scholar who says her background growing up in the developing world contributed to her innate desire to pursue a career with an element of social impact. And she says that background had a fundamental impact on the voice she brings to the U.S. healthcare market and to her leadership style.

Bryony spent the first decade of her career at McKinsey & Company providing strategic and operational counsel to a wide variety of clients across Europe and Africa. After relocating to the U.S. in 2011 and being named a Partner in McKinsey’s Chicago office, she worked with the Center for Medicare and Medicaid Innovation (CMM) and advised numerous healthcare CEOs and government leaders seeking to improve systems of care and transform payment models.

After leaving McKinsey, Bryony spent two years as Chief Strategy Officer at Blue Cross North Carolina and then joined Anthem as Chief Strategy Officer. In September 2021, she was named President of Anthem Health Solutions where she is now responsible for ensuring that the more than 45 million consumers in Anthem’s family of health plans have access to high-quality, affordable care.

On this episode of Healthcare is Hard: A Podcast for Insiders, Bryony shared her perspective with Keith Figlioli on a number of topics, including:

• The Fundamental roles of a payer. In Bryony’s view, there are two central issues that define a healthcare payer and its ability to deliver higher quality, lower cost care: how it partners, and how it pays. She points out that organizations signal what they value by the way they pay for care. For example, how paying for care that drives affordability and quality incentivizes collaboration.
• Innovation inside incumbents. There’s a misconception that innovation is not occurring inside large incumbent healthcare organizations, according to Bryony. She says startups do not have a monopoly on smart people taking thoughtful approaches to the complexities and challenges of the U.S. healthcare system that have developed over decades. While the journey may be slower in these organizations, she says the difference is that they have a longer track record for sustainability – one of the most important factors in U.S. healthcare. She believes in approaching the market with a deep sense of humility for the people and companies that have come before us.
• Advice for entrepreneurs. Bryony says so many potential partners and vendors looking to do business make promises on issue like financial savings or Medicare star ratings. She jokes that if she added up these promises, Anthem would be a 23-star plan. When asked how entrepreneurs and startups can work best with Anthem, she warns of the importance of honesty – but says it needs to come from both sides of the table. Startups should expect honesty from a large company on things like payment and implementation cycles. But they need to be honest about what they have actually delivered versus what they hope to deliver. Don’t pretend you have a track record when you do not, because if you’re honest about what you hope to deliver, a company like Anthem could work closely with you to help make it happen.

To hear Bryony and Keith talk about these topics and more, listen to this episode of Healthcare is Hard.

Walmart is the world’s largest retailer with revenues surpassing $120 billion and more than 10,000 locations across the globe. With nearly 5,000 locations in the United States, 90% of Americans live within 10 miles of a Walmart store.

No conversation about the role retailers are playing in healthcare disruption would be complete without including Walmart. So to close a thee part series of retail interviews that also included the Chief Medical Officer at Walgreens and Chief Strategy Officer at CVS Health, Keith Figlioli spoke with Walmart’s Chief Medical Officer, Dr. John Wigneswaran, for this episode of Healthcare is Hard.

Dr. Wig, as he‘s known, says he never expected to be working at Walmart when he was in medical school. And in fact, even though his father was a pediatrician, a career in medicine seemed to be a remote possibility early in life when he was following his passion for music and signing a record deal. But since then, Dr. Wig has led an impactful career with a variety of roles in the pharmaceutical, medical device and healthcare services industries, after more than a decade of clinical experience as a practicing nephrologist.

Before joining Walmart this year, Dr. Wig was CMO at Express Scripts. He also served as CMO at DaVita Rx, VP of Market Development at Fresenius Medical Care, and Medical Director in medical affairs at Johnson & Johnson (Scios Inc.), among other roles.

Dr. Wig’s conversation with Keith Figlioli about Walmart’s growing role in healthcare covered a number of topics including:

• Meeting people where they are. Dr. Wig says that finding ways to fit health care into peoples’ day to day activities is a core focus for Walmart. This allows people to avoid rearranging their lives around traditional healthcare structures, and also expands the type of care available to them. Walmart’s omnichannel capabilities can provide the flexibility that people need – especially when it comes to complex and costly interventions around chronic diseases. For example, this could include a person with diabetes being educated about healthy foods or a telepharmacy encounter for someone with an educational need.
• Building community trust. Most retail settings are about more than just shopping, according to Dr. Wig. People go to their local Walmart store for many reasons, some to simply walk indoors for the exercise, but overall for a sense of community. Dr. Wig says trust is becoming much more local and recognizes the opportunity and responsibility Walmart has to be a place where people can turn for their healthcare needs.
• The power of data. Walmart has long been known as a pioneer in the way it uses data to improve operations and better serve customers. The company can apply that same know-how and discipline to using data in way that can improve healthcare. Dr. Wig says the company is very focused on the privacy and security aspects of healthcare data and determining how to bring its many sources of data to bear in a safe and responsible way.

To hear Dr. Wig and Keith talk about these topics and more, listen to this episode of Healthcare is Hard.

In the United States, 85% of the population resides within 10 miles of a CVS Pharmacy. Through continued growth and expansion since its founding as a health and beauty products retailer in the early 1960s, CVS Health has now become America’s largest health services company. That expansion accelerated over the last two decades through acquisitions of companies like MinuteClinic, Caremark and Aetna that embedded CVS even more deeply into the U.S. healthcare system and communities across the country.

Josh Flum has played key roles in CVS Health’s transformation and healthcare strategy for nearly 20 years. After Yale Law School and a few years as a white-collar criminal defense attorney in Washington, DC, Josh decided on a career change and landed a job at Boston Consulting Group where he first crossed paths with CVS. In this episode of Healthcare is Hard, Josh tells Keith Figlioli about one project at BCG where he was begrudgingly selected to spend two weeks virtually living at CVS pharmacies learning everything there is to know about how they operate. That assignment proved invaluable for the rest of Josh’s career. Since joining CVS in 2004, he has held several senior roles including leading pharmacy operations and overseeing Enterprise Product Innovation and Development teams. He also co-founded and leads CVS Health Ventures, and is currently CVS Health’s Chief Strategy & Business Development Officer.

Josh and Keith covered several pressing topics during this Healthcare is Hard interview including:

•  The next evolution in pharmacy. Josh talks about fundamental shifts in the pharmacy business that have occurred in his career and what he thinks is in store for the future. While the deeply personal connection between people, families and pharmacists has always persisted – and will be integral for the future – the pharmacy business has moved from being about medication fulfilment, to clinical pharmacy care including medication adherence, to other aspects of medical care such as testing and immunizations. Josh says the future will be about pharmacists practicing at the top of their license and balancing clinical care interventions with new technology and the consumer relationships that pharmacists have always maintained.
• The retail threat. Keith posed the same question to Josh that he asked Walgreen’s CMO on last month’s Healthcare is Hard episode: how should incumbent healthcare delivery players think about the emerging role of retailers? To Josh, it comes down to how a company fits into three trends: patient as consumer; care in community, home and virtual settings; and technology. Josh says CVS feels very well positioned to play a big role in the future of healthcare as these trends continue to evolve, while recognizing that the company still has much more to do and will need to work in partnership with the broader healthcare system to make the kind of change that is necessary.
• The flip side of innovation. Through his role at CVS Health Ventures, Josh sees many of the exciting developments that are going to make care easier and more ubiquitous, but sometimes wonders if the pace of advancement could overwhelm consumers. Putting himself in the consumer’s shoes, he says it’s all about trust. He believes consumers will turn to the people and organizations they know and trust to help navigate new experiences – organizations like CVS Health. For its part in the innovation ecosystem, Josh says CVS Health Ventures is currently focusing on investment themes including care delivery, consumer centric healthcare, whole person care and disruptive tech enablement that crosses all these domains.

To hear Josh and Keith talk about these topics and more, listen to this episode of Healthcare is Hard.

Since its first store opened in 1901, Walgreens has been embracing innovation in the retail pharmacy space, fueling its expansion to become a neighborhood health destination with more than 9,000 locations. As the healthcare industry navigates major structural changes – and a global pandemic – Walgreens is staying true to its roots of innovation and guiding what the future of healthcare looks like in America.

Kevin Ban joined Walgreens as Chief Medical Officer in January 2020, and by the end of February was already being thrust into pandemic planning and response. In the short time since, he’s implemented guidelines to ensure customer and team member safety, launched and expanded COVID-19 testing services across thousands of stores, and rolled out COVID-19 vaccinations, all while focusing on Walgreens’ long term goals for the strategic role it will play in healthcare.

During this episode of Healthcare is Hard, A Podcast for Insiders, Kevin draws on these experiences – as well as past roles including time spent as CMO at Beth Israel Deaconess Medical Center, CMO at AthenaHealth, and Professor at Harvard Medical School – in a wide-ranging discussion with Keith Figlioli. They touch on a number of topics including:

• Decades of VBC Lessons – While value based care in America is still in its early days, Kevin has been a student of value-based arrangements for two decades. He describes time he spent in Italy in the early 2000s where he was exposed to the single-payer model, and what he calls the epitome of value based care. For example, he remembers the Italian health system being exceptionally good at delivering care outside of the hospital in a way that the U.S. health system would have never imagined. He also talked about how that background prepared him to become involved with one of the nation’s first VBC experiments – Blue Cross Blue Shield of Massachusetts’ Alternative Quality Contract – at a time when his peers showed little interest. (for more on AQC, listen to the Healthcare is Hard Episode with Pat Gilligan, Chief Commercial Officer at BCBSMA)
• Pairing primary care and pharmacy. In his time at Beth Israel, Kevin says he was amazed at how often plans for patients fell apart because of the challenges with medication management after discharge. These experiences formed Kevin’s beliefs about the imperative for getting medication reconciliation right. He says that any time you can pair primary care and pharmacy together thoughtfully, it will drive better outcomes, and talks about different strategies for ensuring synergy in the future.
• Community care and retail’s role. Kevin knows how important the last mile of care is and says that connecting with people outside of the hospital was a continued source of frustration during his time at Beth Israel. However, that paradigm is completely different at Walgreens. People trust their pharmacist because they’re accessible and deeply knowledgeable, but overall, they’re an underutilized resource within the health system. While not long ago, it’s even difficult for Kevin to remember a time before pharmacies administered flu shots. And now, people go very comfortably to their local pharmacy for vaccines and testing, making them an important new site for primary care – just as Walgreens is delivering through its investment in and partnership with VillageMD.

To hear Kevin and Keith talk about these topics and more, listen to this episode of Healthcare is Hard. 

Investments in digital health hit an all-time high in 2020, only to surpass the new record within the first six month of 2021. Needless to say, there’s never been more attention placed on digital health innovation. But it makes for a crowded market, putting providers and health system CIOs in a challenging position where it’s impossible to vet the wave of new technologies and determine what will really help reduce costs and improve care.

For 25 years, KLAS has helped providers navigate the increasingly complex healthcare IT landscape through research that’s focused on amplifying their voice in the market. With a rigorous process of collecting and assembling feedback from the people who actually use healthcare technology, KLAS forces technology vendors to face, act on, and improve from critical feedback, and gives providers a venue to seek advice from their peers.

In this episode of Healthcare is Hard: A Podcast for Insiders, Keith Figlioli talks to the CEO and co-founder of KLAS, Adam Gale. They discuss his firm’s role in the digital health industry over more than two decades, and touch on topics important for providers, vendors, investors and others playing a role in the industry’s future. They cover a number of issues, such as:

•  The beginning of health tech innovation. KLAS was established at what might feel like the beginning of digital health innovation – even before Meaningful Use was implemented – but once again Adam feels like things are just getting started. He talks about being in the right place, at the right time, to be a trusted voice during the nationwide rollout of electronic health records, and the uncertainty KLAS felt for the future once EHRs were in place. But he also talks about how being at the front edge of technology right now reminds him of those early days, and the limitless possibilities that lie ahead.
• Forcing change through public policy or private markets. Touching on a theme from the last Healthcare Is Hard podcast with ONC’s Steven Posnack, Keith and Adam discuss the levers for implementing change in healthcare IT. Adam shares a conversation he once had with Secretary for Health and Human Services, Mike Leavitt, where they both expressed envy for the other’s ability to help implement change. While Adam pictured government as a body capable of setting the course, Secretary Leavitt revealed how difficult this actually is. A slight move in any direction, according to Leavitt, creates waves of pushback from multiple angles. But as a private organization with influence over both vendors and providers, KLAS is in a unique position to drive change and improvements across the industry.
• Advice for entrepreneurs. Adam shares insights throughout the interview that are valuable for digital health startups and entrepreneurs, while providing direct advice at times too. For example, he talks about the strategic importance for early-stage companies to invest in their first customer relationships to develop one or two health system customers that will become good references. He says this might be a slower path to success, but stresses the power that word-of-mouth has in the healthcare industry and how this approach builds real value.

To hear Adam and Keith talk about these topics and more, listen to this episode of Healthcare is Hard.

With great power comes great responsibility and in healthcare, those words may have never held more meaning than they do with the advent of artificial intelligence. AI most certainly has the power to transform healthcare, and those in the industry working to develop and use it have an immense responsibility to shape principles that ensure these technologies help, not harm.

The Coalition for Health AI (CHAI) was created with a mission to be the trusted source of responsible AI in health that serves all. CHAI was founded in early 2021 by a small group of industry stakeholders and has quickly grown to now encompass more than 2,500 participants representing health systems, technology providers, government agencies, advocacy groups and others.

Dr. Brian Anderson is one of CHAI’s co-founders and now serves as its first CEO. Before CHAI, Dr. Anderson was the Chief Digital Health Physician at MITRE, a nonprofit corporation that manages federally funded research and development centers (FFRDCs) supporting various U.S. government agencies. At MITRE he led research and development efforts across major strategic initiatives in digital health alongside industry partners and the U. S. Government.

Prior to MITRE, Dr. Anderson led the Informatics and Network Medicine Division at athenahealth. He has also served on several national, and international, health information technology committees in partnership with the Office of the National Coordinator (ONC), the National Institutes of Health (NIH) and the Organization for Economic Cooperation and Development (OECD).

In this episode of Healthcare is Hard, Keith Figlioli spoke with Dr. Anderson about the origins of CHAI, its intended role ensuring responsible use of AI in healthcare, and the complex issues already emerging as the industry navigates the early stages of AI adoption.

Some of the topics they discussed include:

• Aligning AI with values. Dr. Anderson admits there’s General agreement around principles like transparency, safety, privacy, and reliability when it comes to responsible use of AI. But says the industry needs a clearer definition for what that actually means at a technical level for the people and companies writing code. He says vendors fundamentally can’t do this on their own, which is why independent entities with appropriate skills, tooling, technology, and data are needed.
• AI assurance. Nearly every other industry has independent organizations that test and evaluate products. From the star rating system for automotive safety, to the stickers validating consumer electronics, we take these rating systems and their existence for granted. Healthcare AI does not yet have a similar system, but that’s what Dr. Anderson eventually wants CHAI to be known for.
• Giving everyone a voice. Being inclusive is fundamental to CHAI’s mission and Dr. Anderson stresses that everyone’s perspective is legitimate, especially since healthcare AI is such a new space where no one has definitive answers. He recognizes that listening to every perspective is critical in order to build AI that will serve everyone. For example, this includes ensuring that voices from the startup community are represented just as much, if not more than big tech.

To hear Dr. Anderson and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

The accelerated pace of innovation in digital health, record-breaking investments in the sector and even some of the technology developed to navigate the pandemic wouldn’t have been possible without groundwork laid by The Office of the National Coordinator for Health Information Technology (ONC). And there’s probably no one who understands ONC’s past, present and future role better than Steve Posnack.

Steve is a fixture at ONC, joining a year after it was formed in 2004 and serving for the past 16 years in various capacities through four administrations. Since 2019, Steve has served as Deputy National Coordinator, playing an integral role in policy development, technology initiatives and investments, budget prioritization and industry-wide coordination.

In this episode of Healthcare is Hard, Steve gives a background and history of ONC, explaining how it fits into the Department of Health and Human Services and the overall role it plays in the federal government. He shares insights that anyone in the healthcare innovation ecosystem should understand and his conversation with Keith Figlioli covers a number of topics including:

• Wins and regrets of ONC. As someone who has been at ONC for nearly its entire history, Steve has a rare vantagepoint to reflect on initiatives that have gone smoothly and lessons-learned for those that haven’t. For example, he discusses successes and challenges of Meaningful Use, recognizing its imperfections, but all the innovation that it made possible as well.
• Cybersecurity in healthcare. Steve entered ONC after earning a dual master’s degree in cybersecurity and health policy from Johns Hopkins University, giving him a unique skillset to address the security issues with healthcare IT that are becoming increasingly more critical. He talks about the need for better cyber hygiene industry-wide and shares thoughts about meeting that goal. But he doesn’t predict any federal mandates for security in the near future.
• Improving data quality. According to Steve, poor data quality is a sore point for public health professionals and an area where the private sector can help in order to benefit everyone. He says the people tasked with tracking and consolidating data spend precious time doing “data detective work,” and it’s been especially challenging through the pandemic. This requires looking upstream to know where data is coming from and where it’s going to figure out how gaps occur and how to address them.
• The future role for ONC. Taking all of ONC’s accomplishments into account, Keith and Steve discuss if there’s more work to be done, or if the public sector should start taking over. From Steve’s perspective, there’s a lot for the private sector to build on, but he also says there’s a lot the industry is still asking ONC to push forward. As just two examples, he talks about how work around the social determinants of health and the convergence of clinical and research operations still need broader coordination.

To hear Steve and Keith talk about these topics and more, listen to this episode of Healthcare is Hard.

In the United States, more than 90% of the landmass is rural. And in rural communities from coast to coast, the challenges in delivering healthcare can be very different than the urban and suburban centers that get most of the attention.

There’s untapped opportunity in reimagining healthcare business models and the technology that will enable them in rural areas, according to Ballad Health CEO, Alan Levine. And he should know – in the three years since Ballad was formed by merging Wellmont Health System and Mountain States Health Alliance, it has had exceptional success rewriting the rules of rural healthcare.

Among some of its visible and measurable improvements, Ballad Health has decreased pricing by an average of 17% for urgent care and other physician-based services, cut its mortality rate for trauma in half, reduced low acuity admissions by 16,000 per year, and saved the region in which it operates more than $200 million per year in healthcare costs. And it’s doing this with only a 20% commercial payer mix.

In this episode of Healthcare is Hard, Alan talks to Keith Figlioli about how Ballad Health is achieving these milestones by better understanding the dynamics of rural healthcare and making big structural changes to address them. He shares specifics about many of the changes Ballad has already implemented and his plans to continue down this revolutionary path. Their conversation covers topics including:

• Trading competition for regulation. In the areas of Tennessee, Virginia, North Carolina and Kentucky where Wellmont and Mountain States operated, only 50% of hospital beds were occupied and rates were declining. To survive and give it stability, Wellmont looked to be acquired by an outside system, until Mountain States stepped in with a unique solution to merge. But the FTC opposed the merger every step, forcing legislation in Virginia and Tennessee followed by approval from both states’ governors, attorneys general and health commissioners. Against significant odds, the merger was approved with Ballad agreeing to cap pricing and price increases at a rate well below the hospital consumer price index (CPI).
• Eliminating duplication. Many of the structural changes at Ballad Health revolved around reducing duplicate services. Intense competition between Mountain States and Wellmont forced one system to always keep up with the other. As a result, a small town like Greenville, TN had two hospitals a little over a mile apart which had both lost $70 million at 30% capacity in the years leading up to the merger. One of Ballad’s key goals is to implement a more rational approach and business model that makes sense for rural areas.
• Transforming from hospitals to health improvement. While reducing duplication, Ballad is thoughtfully applying the resources it saves to improve the health of its communities upstream. For example, in one region where it consolidated hospitals, it converted one building into a residential facility for women who are pregnant, homeless, drug addicted or have other needs. It gives these women housing security, food security and resources to help ensure their babies are born into a healthy situation.
• The new competitive landscape. Alan says his biggest competition is no longer the health system or physician group down the street. It’s the tech-enabled company across the country or a retail chain that could provide primary care. And unlike health systems in urban areas that can offset the loss of a patient with populated growth, there’s nothing to replace that loss in a rural area. This is why technology will play a significant role in the transformation of rural healthcare.

To hear Alan and Keith talk about these topics and more, listen to this episode of Healthcare is Hard.

Dr. Farzad Mostashari’s extensive resume doesn’t fully convey the true value he brings to reimagining healthcare. He’s the former National Coordinator for Health IT at the Department of Health and Human Services, served as assistant commissioner at the New York City Department of Health, was an Epidemic Intelligence Service officer at the CDC, a fellow at The Brookings Institution and a resident at Mass General Hospital. Yet, with all that experience, he says living through the Iranian revolution before moving to the U.S. at age 14 is what fuels his ability to see things differently.

As he told Keith Figlioli, “seeing an actual revolution does something for your sense that things can change; that you can be looking at one reality one day, and a different reality the next day.”

In this episode of Healthcare is Hard, Farzad talks about how he’s never been totally comfortable inside – or even leading – the grand institutions he’s been part of, and at some level, has always felt like an outsider. He describes his ability to see the insider and outsider perspective, his natural disposition to see things differently, and how this trait led him to found Aledade.

Most of the industry looked at the Medicare Shared Savings program in the Affordable Care Act and assumed that hospitals needed to be at the center of creating and sharing in savings. But after noticing the law didn’t require a hospital, Farzad began building a network of primary care doctors who could treat people upstream, reduce hospitalization and lower costs.

Seven years later, Aledade has assembled 800 practices in 35 states and has $12.5 billion in annual medical spend under management. It’s helping independent physician practices deliver better care, reduce overall costs and preserve their autonomy in communities all across America.

Farzad brings his outsider mentality and inclination to see things differently to his conversation with Keith Figlioli on this episode of Healthcare is Hard. They cover a number of topics including:

• Dis-economies of scale. Farzad talks about how healthcare is one of the few industries where organizations tend to lose money as they get bigger, and how it all maps back to fee-for-service. The main driver of consolidation in healthcare has been the need to build leverage at the negotiating table. But he says if you change the rules of game – including what’s being valued, rewarded, and compensated – you actually see that the small guys do better.
• Independent vs. Institutions. Farzad sees this as a proxy battle. He says if you’re betting fee-for-service will be the future of healthcare, bet on consolidating health systems. But if you’re betting on value, bet on the independents.
• Trust in policy makers. As someone who has lived on both the public and private sides of healthcare, Farzad sees that many people in the private sector are highly skeptical of healthcare policy makers. But in his experience, smart policy makers are motivated by evidence and doing the right thing to help improve care and lower cost. He says leaders in the private sector who understand this are in a better position to navigate the potential regulatory risk impacting their business.
• A decade of vision driving real value. It’s taken a long time to build much of the infrastructure that started under Farzad’s leadership at ONC almost ten years ago. And now, the combination of new incentives with data-driven capabilities the industry has talked about for a long time are very real. These elements have already created billions of dollars in value that couldn’t exist before, and that impact will continue to multiply.

To hear Farzad and Keith talk about these topics and more, listen to this episode of Healthcare is Hard.

Dr. Sachin Jain says he got a silent education about healthcare and medicine around the dinner table from his father, an anesthesiologist and pioneer in pain management. But he still wasn’t sold on a career in healthcare until the end of his junior year at Harvard when he took a course on the quality of healthcare in the U.S. taught by Dr. Howard Hiatt and (one of this podcast’s first guest) Dr. Don Berwick.

That decision kicked-off a career where Sachin has packed experience from nearly every angle of the healthcare industry into the last 20 years. Immediately following his junior year at Harvard, Don Berwick offered him a summer internship with the Institute for Healthcare Improvement (IHI) working on its Pursuing Perfection Initiative. This provided an opportunity to visit and study the nation’s best health systems at Don’s side and opened the door to a tremendous network of national healthcare leaders.

A few year later, Sachin landed in Washington, DC as Special Assistant to the National Coordinator for Health IT during the Obama Administration and then Senior Advisor to the CMS Administrator (his mentor, Don Berwick). He then jumped back to the provider side as a resident at Brigham and Women’s Hospital in Boston for four years, before seeing healthcare through the pharmaceutical lens as Chief Medical Information and Innovation Officer at Merck. In 2014, he was recruited to the west coast by Anthem Blue Cross Blue Shield, where he was CEO of its subsidiary, CareMore Health, a care delivery system for Medicare and Medicaid patients, and CEO of Aspire, a large palliative care provider that was acquired by Anthem in 2018.

In July 2020, Sachin became CEO at SCAN Health Plan, a non-profit founded as the Senior Care Action Network in the late 70s that’s now a Medicare Advantage HMO with 220,000 members and revenues over $3.5 billion.

At SCAN, Sachin has continued his commitment to disrupting the status quo in healthcare. On this episode of Healthcare Is Hard, he discussed many of his ideas with Keith Figlioli, including:

• Making hospitals less necessary. A few years back, Sachin was in the running to lead a nationally-known integrated health system and laughs at himself when he thinks of his final pitch to the board. He argued for revenues to go down, fewer beds and facilities, less fee for service revenue, and more risk-based revenue. While he fully understands how this goes against everything driving health systems for the past two decades, it aligns with his fundamental belief that healthcare needs to focus more intensely on outpatient management of people with chronic diseases to keep them out of hospitals as much as possible.
• Medicare advantage as a blueprint of Medicare for all. Sachin says he doesn’t think Americans trust the public sector to fund and provide healthcare, but he believes people could get behind healthcare that is government funded and privately delivered. With elements like a coordinated network, transparency around quality, incentives for consumer experience, and rewards for higher participation, he believes MA could be a solution to full coverage.
• Islands of innovation. While Sachin sees lots of creativity and reinvention around individual verticals and addressing single diseases, he’s frustrated with the lack of connective tissue between them and thinks this will get worse before it gets better. He says the next phase will have to be focused on connecting all these pieces to treat the full patient and that it will be incumbent on private markets to think creatively about deal structure to incentivize it.

To hear Sachin and Keith talk about these topics and more, listen to this episode of Healthcare is Hard.

Improving patient experience has been a driving focus for Winjie Miao during her twenty year career at Texas Health Resources, where she’s now senior executive vice president and chief experience officer. Texas Health cares for more patients in North Texas than any other provider through 350 access points including 27 hospital locations and a network of outpatient facilities, Neighborhood Care & Wellness Centers, preventive and fitness services, and home health services.

After joining Texas Health, Winjie spent 15 years in hospital operations – first at one of the system’s largest hospitals and then at its smallest. She then embarked on a unique opportunity to build a new hospital where she planned, implemented and piloted new technology in a way that wouldn’t have been possible at an existing hospital campus.

In 2015, Winjie joined Texas Health’s executive leadership team and a year later played a significant role developing its 10-year strategic plan, Vision 2026, which made patient experience a central focus. In three phases, Texas Health planned to understand everything it could about healthcare consumers, build new capabilities to activate consumers, and finally capture value for both consumers and the health system itself.

Nearly halfway through its strategic plan, Texas Health had already piloted virtual primary care by the beginning of 2020 and planned a phased rollout through the rest of the year. Then COVID hit.

In this special episode of Healthcare is Hard, recorded as part of the Digital Health Innovation Summit (DHIS) Virtual Spotlight Series, Winjie talks to Keith Figlioli about what Texas Health has learned through this process and how she sees the future of home health unfolding. Their conversation covers a number of topics, including:

• One giant pilot. While Texas Health was well on its way to piloting and implementing options for virtual primary care at the beginning of the pandemic, Winjie talks about how the first two or three months of going almost entirely virtual were still a huge learning experience. She says it forced significant changes from the original plan.
• Barriers to integrated virtual care. When it comes to telehealth, Winjie sees it becoming an integrated part of the care workflow within the next three years, but she discusses internal and external barriers to overcome first. These include ensuring that equal reimbursement rates for in-person and virtual visits remain permanent, and determining where new business units or processes need to be newly created, and where old ones can be adapted.
• A thoughtful and measured approach. Winjie points out the importance of recognizing that home health is right for certain groups, and not for others. Without reliable internet, the ability to connect multiple at-home remote monitoring systems, a support system or family member who can be there and be part of the care team, and other essential variables, home health is not the best form of care for many people. But it is absolutely the best place for others, and that determination needs to be made in a very deliberate and pragmatic manner.
• A fast start, but long road to home health. Many people, both inside and outside of the healthcare industry, look at the progress that’s been made due to the pandemic and think telehealth has arrived. But Winjie talks about all the work that still needs to be done, especially when it comes to connecting different types of virtual care platforms that have all matured at different rates. She says connecting them in a way that’s meaningful for the patient and the care giver is still a few years away.

To hear Winjie and Keith talk about these topics and more, listen to this episode of Healthcare is Hard.

Last year tested nearly every aspect of the healthcare system, making the 2021 J.P. Morgan Health Care Conference like none other in its 39-year history. But there’s at least one constant from the past few years – the insight Dan Michelson, CEO at Strata Decision Technology, offers in the recap he writes for Becker’s Hospital Review.

With a customer base that includes 2,000+ hospitals and 400+ healthcare systems, about half of all U.S. healthcare flows through Strata’s financial analytics and performance platform. Needless to say, this gives Dan a unique vantagepoint to observe and add context around the discussions healthcare’s most influential leaders have at JPM every January.

Dan’s biggest takeaway this year? While the pandemic stretched providers to the limit – placing extreme demand on care delivery and untold pressures on their financial stability at the same time – the system proved that it’s too vital to fail. But If providers want to be able to say the same thing ten years from now, they’ll have to look and operate much differently than they do today.

Just like last year, Dan talked to Keith Figlioli for a special Healthcare is Hard episode where they dissect the ideas from JPM that set the stage for the months and years ahead. They talked about what was lost and gained by holding the event virtually, but more importantly, what they took away that will help health systems – and everyone that supports them – build back stronger. Some of the topics they discussed include:

• The Mindset for 2021. Everyone thinks the future is hard to predict, but at this point in healthcare, Dan says it really isn’t. Strata has been working with a cohort of about 50 health systems throughout the pandemic to study patient volumes and utilization, publishing findings every two weeks that have become a monitor for the financial and operational impact of Covid-19. Based on the data, he expects volumes in 2021 to remain at their current levels (which are down across the board from 2019) through most of year and begin to pick back up in the fourth quarter. He says the mindset health systems have this year is to “keep it going as best we can” and that 2022 will be the year they expect a return to “normal.”
•  Proving the Payvider Model. As the disconnect between payer and provider continues to cause frustration for consumers, integrated models that align incentives have provided relief, offering a better experience at a lower cost. And the financial stability that integrated systems experienced through the pressures of the pandemic offered another very important proof point for the future of the payvider model. Dan points to Intermountain Healthcare – and former Healthcare is Hard guest Bert Zimmerli – as an example to emulate.
•  The Year of Digitizing Operations. Dan expects to see a very big swing back to managing costs and driving productivity through automation and digitization in 2021. There was no time to worry about cost last year, but as volume remains low and the payer mix impairs profitability, innovation and efficiency are coming back into focus.
• Following the Money to Home Health. Out of necessity, the pandemic pushed home health and telehealth years ahead of where they would otherwise be. But Dan talks about how health systems won’t maintain their support for home health unless financial incentives align. The speed with which this shift happens will depend largely on CMS taking the lead and putting the right incentives in place.

To hear Dan and Keith talk about these topics and more, listen to this episode of Healthcare is Hard.&a

Before the term Value Based Care existed, Blue Cross Blue Shield of Massachusetts (BCBSMA) unveiled one of the nation’s first risk-based payment models – its Alternative Quality Contract (AQC). Patrick Gilligan joined BCBSMA in 2007 to oversee the AQC’s rollout after spending nearly 14 years negotiating contracts on the provider side at Partners Healthcare (now Mass General Brigham). He left BCBSMA for a three year stint at CVS, where he led health system alliances, and is now back at Massachusetts’ largest private insurer as chief commercial officer where he is responsible for all market-facing functions for the health plan and its 2.8 million members.

This episode of Healthcare is Hard taps into Pat’s unique view of the healthcare market that spans payer, provider, and pharmacy/PBM. He talks to Keith Figlioli about the market factors influencing the cost and quality of healthcare, and shares a payer’s perspective on current challenges and the path ahead. They dive into a number of topics including: 

• The downstream impact of deferred care: While the COVID-19 economy translated into nationwide job losses – and therefore a reduction in BCBSMA’s membership – the slowdown in elective services is the more challenging, complex, and long-term issue for payers. Like many other payers, BCBSMA issued rebates to its customers and members in 2020 as a result of lower than anticipated health care costs during the COVID-19 public health emergency. Pat talks about the necessity of managing risk over the long term and the expectation for higher future costs that all payers will have to navigate.
• Elements of VBC success: When Pat first joined BCBSMA to introduce the Alternative Quality Contract (AQC) to providers, he insisted on sharing both upside and downside risk from the outset. Pat credits the universal approach to risk sharing as an element of AQC’s success. He also points to the long-term nature of the contracts BCBSMA offers to providers. A traditional one- or two-year contract can make it difficult for providers to fundamentally change their business – particularly as government rules change – so BSBSMA has entered into three-, five-, and even seven-year AQC agreements. Lastly, he talks about the importance of sharing data, identifying gaps in care, and truly working together once payer and provider interests are aligned.
• Unintended consequences of integrated models: As the lines blur between payer and provider, Pat warns of the potential for losing sight of the mission to improve affordability and quality. He uses pharmacy benefits managers (PBMs) as an example, and how a company like CVS which is traditionally a pharmacy that now operates an integrated model, will make more money prescribing than managing care. He talks about being careful to not deviate too far from what the expertise of a health plan should be and always focusing on the best interest of employers and customers.
• The end goal of experience: Throughout the conversation, Pat returns frequently to the theme of patient/member experience. He talks about driving better experiences through deeper partnerships and how every player in the market offers something important. This includes payers and providers recognizing each other’s core competencies, but also considering where consumer-savvy and digital-first managed care providers are trying new approaches that everyone can learn from.

To hear Patrick and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

As someone who has been in the middle of healthcare policy and reform in the U.S. for decades, John McDonough has a unique perspective on how the rapidly changing political climate in Washington will impact the healthcare industry.

John’s dedication to public health began in 1985 after he was elected to the Massachusetts House of Representatives where he co-chaired the Joint Committee on Health Care until 1997. He later played a key role in the passage and implementation of the 2006 Massachusetts health reform law as Executive Director of Health Care for All, the state’s leading consumer health advocacy organization. With that experience, the U.S. Senate tapped John as Senior Advisor on National Health Reform from 2008 to 2010, where he worked on the development and passage of the Affordable Care Act.

John is currently Professor of Public Health Practice at the Harvard T.H. Chan School of Public Health and is the author of three books including, Inside National Health Reform and Experiencing Politics: A Legislator’s Stories of Government and Health Care.

In this edition of the Healthcare Is Hard podcast, Keith Figlioli asks John to draw upon his years developing and implementing healthcare policy to reflect on the outcome of the recent election and the implications it will have for the healthcare industry. The topics they address include:

• Steering a divided government. John talks about how historically rare it’s been for a Democratic president to take office without majorities in the House and Senate – something that hasn’t happened since Grover Cleveland in 1884. He discusses what that will mean for a Biden administration, unless Democrats are successful in their longshot bid for two Senate seats in Georgia’s runoff elections.
• Presidential regimes that define decades. John shares a theory about how era-defining presidents set a course that lasts well beyond their terms to cross decades and multiple administrations. The last era began with FDR who changed the national discussion and tone when he took office in 1933, and lasted until the end of the Carter administration. The Regan revolution set a new tone in the 1980s, rooted in competition and capitalism, that has impacted all areas of society including healthcare. Historically, each era has ended with a national calamity – the Great Depression during Hoover’s term, the energy and Iran hostage crisis for Carter – and a one term president. John ponders whether the coronavirus pandemic and President Trump’s single term could be the beginning of an era-defining Biden administration.
• The ACA’s little secret. After more than 10 years, John believes the ACA has stood the test of time, causing changes in delivery systems, accountable care organizations, bundled payments and the value-based care revolution to become embedded in the structure of the U.S. healthcare system. The secret about the ACA, he says, is that both Democrats and Republicans support this approach and don’t want to see it dismantled because they don’t have ideas to replace it.
• Strengthening CMMI. President Obama’s administration used the Center for Medicare & Medicaid Innovation as a vehicle for change, and John expects a Biden administration to rely on it even more. He sees a new administration testing the limits of executive authority and being aggressive at using CMMI to take risk and demonstrate feasibility of ideas that can then be implemented more broadly.

To hear John and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Robert Musslewhite has viewed healthcare innovation and the lifecycle of a healthcare services company from nearly every angle over the past two decades. He joined The Advisory Board Company because it was a small but fast-growing organization where he felt he could make an impact, and where he ultimately became chairman and CEO. Under his leadership, the company quadrupled in size to serve nearly 300,000 leaders in over 5,500 hospitals, health systems, and universities worldwide. In 2017, Robert led the successful merger of the Advisory Board Company with Optum – while spinning off its education business – and became CEO of OptumInsight. At OptumInsight Robert is focused on a societal need for strong partners and new solutions for a more modern, high performing and simpler health care system.

In this episode of Healthcare is Hard, Robert shares experiences with Keith Figloli that will resonate with both healthcare entrepreneurs and leaders of large healthcare organizations. He provides valuable leadership advice, offers predictions about how the healthcare industry will evolve over the next decade, and recounts his unique vantagepoints over the past twenty years including:

• Building a high growth startup. When he joined The Advisory Board, Robert’s mandate was to find new growth vectors. He approached this challenge with the realization that nearly every business that undergoes major transformation takes something they’re doing well and finds new ways to apply it. For The Advisory Board, this involved leveraging its world-class research and relationships with hospital leaders, and wrapping technology around them. The timing of this endeavor couldn’t have been better – Robert talks about how this occurred right at a massive boom period for healthcare analytics, how his team capitalized, and the lessons he learned in the process.
• Navigating a multi-billion acquisition. Under Robert’s leadership, The Advisory Board expanded its focus beyond healthcare and into education. Ultimately, he orchestrated the sale of both sides of the business at the same time. Robert talks about the process to seek and identify a potential market partner on the healthcare side, and how Optum – building one of the world’s most comprehensive, digital, information and AI-enabled care platforms – was an obvious fit after the first discussion. He saw how Optum’s capabilities would enable The Advisory Board to broaden its reach beyond hospitals into the changing healthcare market, and how The Advisory Board could help channel Optum’s many capabilities to further modernize health care with a focus on lowering cost while improving the experience for providers and their patients.
• Becoming the acquirer. Now, as CEO at a $10 billion business unit of Optum, identifying innovation inside and outside the business is a key part of Robert’s strategy, and traditional M&A is only one avenue to pursue. For example, Robert’s team works closely with Optum Ventures to get more exposure to startups it might otherwise never see, or it might consider taking minority stake in a company to first bridge gaps in expectations and/or prove a value prop in ways that couldn’t be achieved otherwise. Either way, the key is finding opportunities that provide real and rapid value. Real value because all innovation in healthcare has to be focused on expanding access to coverage, reducing the total cost of care and making the health care system simpler. Rapid value because speed to market in health care can and must be radically reduced so the impact of innovation can be realized quickly.

To hear Robert and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

CommonSpirit Health created one of the largest health systems in the nation by merging Dignity Health and Catholic Health Initiatives in early 2019. It now operates 137 hospitals and more than 1,000 care sites across 21 states, with revenues of nearly $29 billion.

Extending its reach into more communities across the country has enabled CommonSpirit to leverage scale as a means to advance its core mission of expanding healthcare access to all, advocating for those who are poor and vulnerable, and innovating how and where healing can happen.

If a person’s personal journey and early years are what guide them to their calling in life, as CommonSpirit CEO Lloyd Dean believes, it’s no wonder why he and SVP and Chief Strategic and Innovation Officer, Rich Roth, are key parts of a leadership team charged with seeing this mission through.

In this episode of Healthcare is Hard, Lloyd tells his inspiring story of growing up the son of a factory worker who experienced racial inequalities firsthand and saw the impact they have on basic healthcare and life expectancy. He shares his personal journey from being the first in his community to attend a university, to becoming the CEO of one of the nation’s largest health systems and how these experiences drive purpose in this role. Rich Roth recounts his first exposure to the healthcare industry cleaning doctors’ offices where his mother worked as a receptionist, his later roles cooking and cleaning at nursing homes, and ultimately his first job out of college stuffing envelopes and answering patient questions in the billing department of a hospital.

With the foundational influence of these experiences, Lloyd and Rich talk to Keith Figlioli about their role in fulfilling CommonSpirit’s healing mission and how it has changed in the wake of COVID-19. They cover a number of topics, including:

• COVID-19 as the great equalizer. Rich explains how certain elements of a health system like home care, pharmacy or community benefit have historically played a secondary role – part of a strategy, but not leading it – and are now starting to be central components of a system’s identity. COVID-19 has revealed the true vulnerabilities in our healthcare system and these are the things CommonSpirit is thinking deeply about to create the next chapter of healthcare delivery. As Lloyd points out, if we don’t see the inequalities now and address them in a demonstrable way, history will chronicle that as one of the greatest missed opportunities the nation has ever seen.
• Personalizing care for individuals. The U.S. health system has done a poor job personalizing primary care to meet individual needs, according to Rich. For example, behavioral health might be the primary need for some people while food or housing is the biggest concern for others. And different groups of people – women, seniors, Latinx, and many more – need more services specific to them too. The next evolution of care must move away from the “one stop shop” and will require services that understand and better serve each person individually.
• Being part of a community, not just “in” a community. Lloyd shares his prediction that care delivery from health systems, hospitals, clinics and other providers that currently occurs IN the community, will transform to be a bigger part OF the community. And providing a robust health infrastructure with broad access to care will not simply be understood as a moral imperative, but as an economic imperative as well.

To hear Lloyd, Rich and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Chris Coburn has been driving health system innovation for decades. He is currently chief innovation officer at Mass General Brigham (MGB), the nation’s largest academic research enterprise with over $16 billion in annual revenue, 1.5 million patient visits and more than $2.4 billion in research expenditures. MGB also has a managed care organization, out-patient facilities and community hospitals. 7,000 of its faculty are appointed at Harvard Medical School.

As head of innovation, Chris leads a team of nearly 150 people tasked with the worldwide commercial application of the unique capabilities and discoveries of Mass General Brigham’s 85,000 employees. His unit’s business development responsibilities include investing, company creation, international consulting, innovation management, industry collaborations, and licensing. Commercialization revenue exceeds $160 million annually and more than 300 companies have been spun-off from Mass General Brigham in the last decade.

Prior to joining Mass General Brigham, Chris was founding director of Cleveland Clinic Innovations and served for 13 years as its executive leader. During his tenure, Cleveland Clinic spun off 57 companies that raised more than $700 million in equity financing. There were none before his arrival.

In this special episode of Healthcare is Hard, recorded live at the Digital Health Innovation Summit (DHIS) in Boston, Keith Figlioli led a keynote discussion with Chris about the current state of healthcare innovation. Some of the topics they discussed include:

• Embracing innovation from inside and outside of MGB. Chris described how his organization is tasked with supporting innovation that will help achieve strategic objectives, regardless of where it originates. With the realization that most health systems are large organizations not known for their nimbleness, he shared advice for innovators looking to partner with or sell to them about how buying decisions are made.
• Corporate venture capital in healthcare. With a steady growth in the number of health systems creating their own venture arms over the past several years, Chris shared best practices from being in the space for decades. For example, he talked about balancing the commitment to both strategic and financial goals, and how his organization catalogs the unmet needs of MGB’s leading faculty. For entrepreneurs, he suggests getting to know the growing number of people in corporate venture roles, in addition to health system operators.
• Getting operators to embrace digital innovation. Fielding a question from the live audience, Chris discussed strategies for getting operators to adapt digital health innovation into established workflows, and how important it is to create a culture around innovation to achieve that goal. On one hand, he talked about how part of his organization’s job is to get doctors to proactively and continuously think about new ways for how they might optimize their work. On the other hand, he talked about listening to unmet needs and addressing them directly as a way to ease adoption from the start.

To hear Chris and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Tal Heppenstall has a dual role at UPMC. He’s been treasurer of the $21 billion dollar health care provider and insurer since 2003, where he’s responsible for the day-to-day cash needs of an organization that integrates 90,000 employees, 40 hospitals, 700 doctors’ offices and outpatient sites, and a 3.9 million-member Insurance Services Division. In addition, Tal is president of UPMC Enterprises, where its mission is to create products and businesses that make life changing medicine happen.

In this episode of Healthcare is Hard: A Podcast for Insiders, Tal talks to Keith Figlioli about the elements that have created this unique, world-class organization and how it will continue to adapt in a post-COVID world. They address topics including:

• A Culture of Risk. According to Tal, one defining factor that sets UPMC apart from other non-profits is its tolerance for risk. It’s a theme he points to throughout the interview, talking about how the organization’s high risk tolerance enabled its success on the payer side, but how it is also an inherent characteristic of an academic medical center. Innovation is why UPMC exists, but Tal believes that without the willingness to take risks, it’s just a word.
• Constant Reinvention. Another important part of being rooted in an academic medical center is the bias towards discovery and reinvention. This has always been core to UPMC, but especially in the current environment as big tech, retail and others enter the market, innovation is not optional. However, Tal is quick to point out that the corporate venture operation under UPMC Enterprises is not a fund. It’s not about short term returns, but rather a reinvestment to make sure the organization is successful in its mission.
• UPMC’s Best Startup Ever. Innovation has resulted in a financial difference at UPMC, but one startup stands out in Tal’s mind – the health plan UPMC created in the late 90s. It’s now the largest medical insurer in western Pennsylvania with revenues of $12 billion. Tal recounts an environment in the market where one payer dominated for years and how competitive rates forced UPMC to do more with less. UPMC in turn became a very efficient organization and, as Tal puts it, is why they chose to do more with less of their own money instead of relying on another payer.
• The Pervasive Impact of COVID-19. Tal and Keith’s discussion reflects the fact that COVID-19 has permeated into every aspect of healthcare and is not a single topic of discussion, but an important part of every topic for the healthcare industry. Throughout the interview Tal shares his thoughts about COVID including how it has accelerated digital health, the challenges it has created for payers and providers, and the role government will continue to play driving change in response.

To hear Tal and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Michael Allen has unique expertise in healthcare finance. He’s been chief financial officer at four different health systems and is national chairman of the Healthcare Financial Management Association (HFMA) where he regularly interacts and shares knowledge with peers in the 56,000-member organization.

Michael calls HFMA his side hustle and is going on his second year of a one-year term since the organization froze its leadership to provide stability during the COVID-19 pandemic. His primary role is CFO at OSF Healthcare, a faith-based health system in Peoria, Illinois with 23,600 Mission Partners in 147 locations, including 14 hospitals.

Since the pandemic started, the Healthcare is Hard podcast has explored how health systems are dealing with it from multiple angles including from the CEO, CIO, regulatory, governance and supply chain perspective. In this episode, Keith Figlioli talks to Michael Allen to learn how finance leaders are supporting the healthcare industry and their organizations through this trying time.

Michael talks about how healthcare has historically not been very agile because realities like fixed costs, reliance on bricks and mortar and steady organic growth meant that it didn’t have to be. But he talks about the new need for agility, how OSF is adapting, and how some steps the organization took before the pandemic put it in a better position to respond. The topics Michael and Keith discuss include:

• Supporting quick decisions. Through its emergency operations center created to navigate the pandemic, Michael says OSF learned how slow the organization had previously been at making decisions. This wasn’t an issue before because it worked, but COVID forced a need for change. Instead of including everyone in every decision, Michael talks about how OSF learned to rely on small groups to make decisions, vet those decisions with the larger group, and then move forward quickly.
• Spending less time in the rear view. Michael is working to flip the traditional model of healthcare finance. Instead of looking backwards and planning based on previous experiences, Michael is directing his team to spend most of their time looking forward. For example, no one in healthcare knows what their future revenue stream will look like as the payer mix shifts and the average payment rate for services is likely to decline. This is why it’s critical for finance teams to spend more time forecasting and ensuring they’re nimble enough to respond to any situation.
• Eliminating the annual budget process. OSF entered its fiscal year starting October 2019 without a traditional budget. Michael and his team still updated their long-term financial plan and set financial targets on an annual basis, but spent less time on individual line items. Instead, they focused more on forecasting and dynamic planning, including measurement and processes for reacting to issues. This proved to be invaluable when the pandemic hit and as the healthcare industry faced rapid change, enabled OSF to quickly gather the information it needed, build forecasts, and move quickly.
• Creating an environment where innovation is inherent. Another area that bolstered OSF’s response to the pandemic is its focus on innovation – something Michael says has always been an integrated part of the organization versus a separate entity. In OSF’s venture arm for example, investments are never solely made for their financial benefits, but must also be doing something positive for the organization and be endorsed by clinical leaders. As the response to COVID-19 placed digital touchpoints first, this gave OSF a running head start in how it adapted.

Hear Michael and Keith dig into these topics and more in this episode of Healthcare is Hard: A Podcast for Insiders.

Cedars-Sinai is a nonprofit academic healthcare organization that serves the diverse Los Angeles community through more than 40 locations, 4,500 physicians and nurses, and 1,500 research projects in motion. Darren Dworkin has been Chief Information Officer at Cedars-Sinai since 2006, where he also founded the Cedars-Sinai Accelerator and serves as managing partner of Cedars-Sinai Health Ventures.

In this episode of Healthcare is Hard, Darren talks to Keith Figlioli about the impact of COVID-19 through a technical lens, offers advice to innovators and entrepreneurs selling to health systems during this difficult time, and shares broad views into the digital transformation of healthcare. Some of the topics they discuss include:

• Enabling Remote Work Through COVID. Many healthcare workers have been bravely carrying out their roles within the hospital setting during the pandemic. But the fact that a large portion of healthcare workers have been asked to work remotely – just like in other industries – hasn’t gotten much attention. Darren points out that in only four days, Cedars-Sinai shifted from having 400 people working remotely to having well over 4,000. He talks about how the health system’s technical infrastructure scaled to handle the demand.
• Lasting Impacts. One of the silver linings Darren sees emerging from the pandemic is how it will advance strategies around helping patients interact with technology in the right ways. While Cedars-Sinai had already been relying on technology for urgent care and primary care visits, he uses the example of post-surgical follow-up as one area where telehealth has, and will likely continue to be very beneficial. As he points out, surgeons prefer to operate, so if they can minimize the time they spend on follow-ups, it’s a win all around.
• Pulling Versus Pushing Technology. Darren recognizes that his role as CIO is to “help engage end users in the tech that we have.” In other words, push technology on the enterprise. But part of the reason he finds the work of the Cedars-Sinai Accelerator so rewarding is that it’s exactly the opposite. Clinical and operational leaders get to choose which companies should be in the accelerator based on their needs and the solutions that will solve their biggest challenges. As an academic medical center, Darren sees innovation and discovery as core to the overall mission at Cedars-Sinai, and its accelerator is a big part of that.
• Advice for Entrepreneurs. Darren’s biggest advice for digital health entrepreneurs is to focus on real savings. Just as we’re approaching a day of reckoning for tech IPOs where companies planned to layer on growth without profitability, the environment for digital health startups is similar: adding improvement without adding bottom line ROI may no longer be sufficient. For example, as companies think about expanding their product, Darren suggests thinking about how to broaden into an adjacent space – versus simply of adding more “bells and whistles” – in order to help health systems eliminate vendors and streamline costs and administration.

To hear Darren and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Over the course of nearly 20 years as Chief Research Officer at The Advisory Board Company, Chas Roades became a trusted advisor for CEOs, leadership teams and boards of directors at health systems across the country. When The Advisory Board was acquired by Optum in 2017, Chas left the company with Chief Medical Officer, Lisa Bielamowicz. Together they founded Gist Healthcare, where they play a similar role, but take an even deeper and more focused look at the issues health systems are facing.

As Chas explains, Gist Healthcare has members from Allentown, Pennsylvania to Beverly Hills, California and everywhere in between. Most of the organizations Gist works with are regional health systems in the $2 to $5 billion range, where Chas and his colleagues become adjunct members of the executive team and board. In this role, Chas is typically hopscotching the country for in-person meetings and strategy sessions, but Covid-19 has brought many changes.

Almost overnight, Chas went from in-depth sessions about long-term five year strategy, to discussions about how health systems will make it through the next six weeks and after that, adapt to the new normal. He spoke to Keith Figlioli about many of the issues impacting these discussions including:

• Corporate Governance – The decisions health systems will be forced to make over the next two to five years are staggeringly big, according to Chas. As a result, Gist is spending a lot of time thinking about governance right now and how to help health systems supercharge governance processes to lay a foundation for making these difficult choices.
• Health Systems Acting Like Systems. As health systems struggle to maintain revenue and margins, they’ll be forced to streamline operations in a way that finally takes advantage of system value. As providers consolidated in recent years, they successfully met the goal of gaining size and negotiating leverage, but paid much less attention to the harder part – controlling cost and creating value. That’s about to change. It will be a lasting impact of Covid-19, and an opportunity for innovators.
• The Telehealth Land Grab. Providers have quickly ramped-up telehealth services as a necessity to survive during lockdowns. But as telehealth plays a larger role in the new standard of care, payers will not sit idly by and are preparing to double-down on their own virtual care capabilities. They’re looking to take over the virtual space and own the digital front door in an effort to gain coveted customer loyalty. Chas talks about how it would be foolish for providers to expect that payers will continue reimburse at high rates or at parity for physical visits.
• The Battleground Over Physicians. This is the other area to watch as payers and providers clash over the hearts and minds of consumers. The years-long trend of physician practices being acquired and rolled-up into larger organizations will significantly accelerate due to Covid-19. The financial pain the pandemic has caused will force some practices out of business and many others looking for an exit. And as health systems deal with their own financial hardships, payers with deep pockets are the more likely suitor.

To hear Chas and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.