Introduction to Creating a New Healthcare. A podcast series for Primary Care Physician leaders who are looking for fresh perpsectives, new solutions and inspiration in their journey to advance value based care.
Episode #115: The Tangelo Park Program - A Model for Breaking the Cycle of Educational Inequity & Transforming Our Country One Community at a Time
You are going to hear a remarkable case study about a successful and sustained philanthropic initiative focused on educating disadvantaged youth. Although outside of the strict domain of healthcare delivery, this initiative is actually about the health & well-being of our communities and our country - education being a significant social determinant of health outcomes.
Joining us in this interview are Harris Rosen, President & COO of Rosen Hotels & Resorts, Dr. Chuck Dziuban, and JuaNita Reed. Dr. Dziuban is the Coordinator of The Harris Rosen Foundation educational programs for the University of Central Florida. He is in charge of maintaining the research and statistics of the Tangelo Park Program. JuaNita Reed is a recently retired guidance counselor at Dr. Phillips High School. She has mentored the scholarship recipients in the program and continues to lead that aspect of the program in her new role as Scholarship Coordinator of The Harris Rosen Foundation.
In this episode, we’ll discover:
The key components contributing to the success & 26-year sustainability of the Tangelo Park Program.
The profound educational outcomes & remarkable impact it’s had on the community - for example, dropping the crime rate by ~80%!
Mr. Rosen’s vision for spreading the Tangelo Park Program to the rest of the country.
Since 1994, Harris Rosen and his colleagues have funded a Pre-K program and a full college scholarship in a small, disadvantaged community. Although the solution is simple, the success is startling. Also startling is how this program has not only sustained itself but has activated the youth and catalyzed the parents in the community. Over the years, families have required and requested less of the Rosen funding, as they’ve been acquiring more college scholarships on their own. Another critical point to understand is that this approach is reversing an insidious, self-perpetuating driver of financial disparity & inequity in educational opportunity.
If you live in the bottom economic quartile in this country, your chance of graduating from college is 11%. The odds against you are 9:1. The total college debt in the USA is $1.7 Trillion dollars. Most of this college debt is carried by the bottom economic quartile in this country, and by Black youth. It is a compounding problem which perpetuates a cycle of debt and the suppression of upward mobility, largely in the Black & LatinX populations. One of the brilliant things that the Tangelo Park Program does is break this cycle of educational debt and upward social mobility. The evidence for that - well, for starters, the Tangelo Park program has reversed the odds of these kids graduating college, from 9:1 against, to 3:1 in favor! Further evidence - over 160 Tangelo Park youth have graduated from college. That is 3 times the expected number, which would have been 45. In addition, the program has resulted in 227 degrees, including post-graduate degrees. There’s also a positive economic impact to the community. Lance Lochner, an economist at the University of Western Ontario, recently calculated a 7:1 return to the community.
Harris Rosen's program is catalyzing the tremendous intellectual talents, capabilities and potential in our disadvantaged youth, particularly in Black & LatinX youth. He understands that a college or vocational school education leads to employment, financial stability, and significantly higher life-time earnings. Those are well substantiated facts. At one point in the discussion, Chuck Dziuban refers to a recently published landmark study which has demonstrated that a Preschool (Pre-K) education positively and cumulatively transforms an individual’s entire life, with ripple effects on the lives of their children & grandchildren.
I suspect that you will be as moved as I was by this story. But Harris is asking for more. Harris Rosen is call
Episode #114: Reducing the Costs of American Healthcare - One Percent at a Time, with Zack Cooper, PhD
The focus of this interview is on a solution created by Yale Economists to address the rising & unsustainable costs of healthcare in our country. Most of us are aware that healthcare costs are a problem, but our guest today argues the cost of healthcare is actually devastating to American workers & families. The approach he and his colleagues are taking to solve this massive problem is unique & I’m excited to explore it with you today.
Zack Cooper, PhD is an Associate Professor of Health Policy and Economics at Yale University. Cooper has published his research in leading economics & medical journals and has presented his research at the White House, the Department of Justice, the Federal Trade Commission, & the Department of Health and Human Services. Cooper received his undergraduate degree from the University of Chicago and his PhD from the London School of Economics.
In this episode, we’ll discover:
The meeting at 10 Downing Street that led this extraordinary Yale Healthcare Economist to come up with the idea for 1% solutions.
The specific healthcare issues being addressed by these 1% solutions, such as Surprise Medical Billing & Kidney Transplantation.
Why Zack believes employer-based health insurance is contributing to bloated costs that are profoundly harming the health & welfare of working Americans.
How the unprecedented drop in American life expectancy and the American epidemic of “deaths of despair” might be linked to healthcare economics.
Why the 1% solutions are intentionally focused on incentivizing providers & healthcare organizations rather than attempting to change patient behaviors through cost-sharing and other demand-side interventions.
The opportunity cost to the American public and the American future resulting from bloated healthcare costs.
This is an extraordinary story of a ‘scholar-activist’ who is battling the insidious mistruths that are guiding policies for an industry that makes up nearly one-fifth of the US GDP. With this latest 1% project, he’s not only debunking harmful myths, but also using evidence-based, scientific methodology to build solutions to lower the staggering costs of healthcare. Make no mistake about it, the stakes are high. For example, Zack refers to a recent study which demonstrated that a $10 increase in Medicare Part D copays (prescription medications) led to a 33% increase in monthly death rates among seniors. People couldn’t afford their medications and so they simply stopped buying them.
Zack is reframing the field of healthcare economics by attempting to accomplish a number of things. First, he is actively recruiting leading scholars to adapt their research to current policy-relevant domains. Second, he is inviting leading scholars to more directly engage with and influence politicians and policy makers. Third, he is catalyzing a movement toward more scientific, peer-reviewed, evidence-based healthcare policy decision-making. Fourth, he is calling for a shift from research that purely critiques to briefs that develop and support tangible solutions to lowering the costs of healthcare. And fifth, he’s influencing the next generation of healthcare scholars to view themselves as ‘scholar activists’.
What Zack & his colleagues are attempting is courageous. They are battling on behalf of the plight of the majority of Americans who simply can not afford healthcare. They are battling the status quo of a huge, well-funded, complicated & opaque industrial complex. As Zack points out, there are few other industries as heavily lobbied as healthcare - underscoring the need for independent, peer-reviewed, evidence-based, policy decision-making.
At one point in the interview, Zack says that he’s been “coarsened” by what he has discovered. He is, in my opinion, experiencing what many clinicians & others in healthcare have recently been term
Episode #113: RosenCare - “The Real Affordable Care Act” with Harris Rosen, Ashley Bacot & Kenneth Aldridge
What if I told you that I just learned of a completely doable and replicable approach to reducing the costs of healthcare by 30 - 50% while increasing quality outcomes simultaneously? In this interview we’ll be speaking with an employer that has been achieving this for years. Corporate America - which pays for 50% of all healthcare costs - has been the “sleeping giant” of healthcare. But these giants are now waking up and they're not going to put up with the status quo. One particular employer has been awake for decades, and we’re going to hear his story told in some detail.
Joining us in this interview are Harris Rosen, President & COO of Rosen Hotels & Resorts; Ashley Bacot, President of Provinsure (the health insurance company that Rosen Hotels formed; and Kenneth Aldridge Jr, RN, BSN, MS-HSA, the Director of Health Services at the Rosen Medical Center and RosenCare.
In this episode, we’ll discover:
The simple but widely successful approach that Mr. Rosen and his colleagues have taken to achieve the triple aim results of better care, better outcomes & lower costs.
Some of the key programs and critical success factors that have contributed to Rosen Hotels having sustained healthcare savings of over 30% for decades.
How ProvInsure and the Osceola County School District have replicated the model with remarkable savings and outcomes.
Mr. Rosen’s vision for spreading the RosenCare model to the rest of the country.Each podcast interview is an adventure for me. To really listen well, I have to allow myself to be surprised. I have to allow myself to think differently and to experience uncomfortable emotions that my guests elicit. In this interview, I found myself surprised with almost every turn of the dialogue.
First, having worked within our overly complicated US healthcare system for decades, I was really knocked back on my heels by the simplicity of Mr. Rosen’s approach to healthcare. It was almost too simple and too obvious; which led me to the second surprise. The emotional dialectic I experienced was embarrassment on one side and inspiration on the other. I was embarrassed and inspired on behalf of the American healthcare system. Here is a guy - Mr. Harris Rosen - with no medical, healthcare or technical background, and he figured it out. I was embarrassed and inspired because here is a leader who did not compromise on what he knew to be the right thing to do for his employees. I was embarrassed and inspired because Harris Rosen had the conviction, commitment and courage to do the things that we all know will radically improve healthcare.
I imagine you’re wondering what Harris Rosen and his colleagues have done. There are a number of ways I could explain it. The simplest way is to tell you that he’s inverted the American healthcare system. RosenCare spends the vast majority of its funding on Primary Care, not specialty care; and makes primary care accessible, convenient, affordable and equitable. RosenCare follows its associates throughout the continuum of care to create a more seamless and integrated experience; and promotes and even imposes the principles of public health by making it a requirement to follow certain healthful behaviors. For example - nicotine use, alcohol consumption affecting “fit for duty” and illegal drug use are not allowable if you’re going to be a Rosen associate.
I’ll share one other emotion I felt as I was listening to the RosenCare story. I felt validated. Having practiced primary care for decades and having been a primary care proponent for over 3 decades, the RosenCare story demonstrates what we have known, and what the literature has repeatedly substantiated. Investing in proactive, preventive primary care leads to better care, better outcomes and lower costs. This is a lesson, sadly, that has not been widely supported or manifeste
Episode #112: What healthcare leaders need to understand about Public Health, with Dr. Tony Slonim, CEO of Renown Healthcare
There aren’t many people who have the breadth of perspective and the depth of accomplishment that this week’s guest brings to the table. Dr. Tony Slonim doesn’t just wear multiple hats. He has lived in multiple healthcare worlds - having earned a nursing degree, a medical degree, a subspecialty board certification, a doctorate in public health; and having served in the public health service as well as in senior executive roles. It is this unique multi-system orientation that enables him to draw distinctions between medical care, public health, community health and population health - distinctions that many of us may not fully appreciate..
In this interview, Dr. Slonim points out that our hospital-based medical healthcare system is not interchangeable with a public health care system. The fallacy that they are interchangeable - and that a public health service is not needed - is a mis-guided national error which has contributed to an American health system which delivers subpar outcomes when compared to other economically developed nations.
By way of formal introduction, Dr. Anthony Slonim is president and chief executive officer of Renown Health in Reno, NV. Modern Healthcare has named Dr. Slonim one of the “50 Most Influential Clinical Executives” in 2019. Before joining Renown Health, he served in executive leadership roles at Barnabas Health in NJ, Carillion Clinic in VA and Children’s National Medical Center in DC. Dr. Slonim holds a diploma in professional nursing. He is a board-certified pediatric intensivist, who also earned a masters and doctorate in public health from George Washington University; and then served four years in the United States Public Health Service in Rockville, MD with the rank of Lieutenant Commander.
In this episode, we’ll cover:
The difference between the ‘medical mindset’ and the ‘public health mindset’.
The reframing of our public health system as an “insurance policy” that our country has not invested in over the past few decades.
Some thoughts on how the defunding of our public health system has contributed to the disparities and inequities in healthcare.
The “precedent of unkindness” in our society - exacerbated by the stressors of the pandemic and perhaps enabled through social media - that is adding to our psychologic and physiologic strain, and harming the public health.
Dr. Slonim is a kind and humanistic leader, but he is also a demanding leader. He is demanding that we reinvest in a diverse healthcare system that works to keep our communities and the American public healthy. What this interview reveals is that the vast majority of us - who have not been trained in public health - don’t understand its significance and its critical role. We don’t understand the differences between public health, population health and medical care. We don’t understand the unique approaches and tools of the public health system. We are not aware that our public health system has been defunded over the past few decades. Nor do we fully appreciate the implications of that defunding, especially in inner cities and rural counties.
Many of the healthcare problems we’re experiencing today - including some of the devastating fallout of the COVID-19 pandemic - are due to this lack of a robust public health system. These problems include: unsafe drinking water (think Flint Michigan); unsafe air; climate change; the racial disparities in healthcare in which life expectancy between neighboring zip codes can vary by as much as 15 - 20 years; the worsening opioid epidemic; and the epidemic of mental health and suicide in our country. All of these have one thing in common. They could be greatly mitigated by the presence of a strong local public health system in our communities, our towns, our cities, our counties and our states.
The pandemic has taught us many things,
Episode #111: Reclaiming the American Dream through Reframing Employer-based Healthcare, with Dave Chase
Our topic this episode may be one of the most misunderstood and challenging issues in healthcare delivery - with significant potential for lowering costs and improving outcomes. The topic is employer-based healthcare; and as many of you know, employers pay for 50% of all the healthcare costs in the US.
Escalating healthcare costs over the past few decades have imposed a major strain on corporate America and its employees. The Kaiser Family Foundation reported that in 2018, employers paid approximately $20,000 per year for healthcare for a family of four, $6000 of which the employee paid. They also reported that since 2006, employee healthcare premiums have risen twice as fast as wages.
As a result, Corporate America has been increasingly focused on right-sizing healthcare costs - from Apple and Amazon launching their own employee primary care; to Walmart providing ‘centers of excellence’ to its employees; to companies such as Comcast who have partnered with vendors to put alternative healthcare solutions in place for its employees.
But, the situation is challenging, as evidenced by the recently failed attempt of Haven, an employer-based healthcare initiative launched by JP Morgan, Berkshire Hathaway and Amazon. It’s a complex ecosystem involving employer-based HR & health benefits managers, employer benefit brokers & benefits consulting companies, insurance companies, provider groups & hospital systems, direct to employer providers, and collaboratives such as the Business Group on Health.
Our guest this week is a passionate expert who has a discerning handle on the ecosystem, the fundamental problems, and the proven solutions in employee-based healthcare.
Dave Chase founded & leads Health Rosetta, whose goal is to empower community-owned health plans. Health Rosetta has created a blueprint and platform that empowers health plans to deliver high quality, affordable care. Dave has authored a number of insightful books including The CEO's Guide to Restoring the American Dream: How to deliver world class healthcare to your employees at half the cost. He received the Health Value Awards' Lifetime Achievement for Health Benefits Innovation at the 2020 World Health Care Congress. Prior to this work, Dave Chase co-founded Avado which was acquired by and integrated into WebMD/Medscape. He also founded Microsoft's $2B, 28,000 partner healthcare ecosystem.
In this episode, we’ll cover:
Dave’s unique perspective on the fundamental problems in the American healthcare system.What Dave describes as epidemic healthcare ‘financial toxicities’ and ‘financial comorbidities’, which is denying the American dream to the majority of employees.Five major solutions that employers can leverage to reset and radically improve their employee health benefits plans. Examples of employers who have saved a significant and sustained percentage of their healthcare costs while improving healthcare outcomes for their employees.Dave makes some amazing claims in terms of dramatically lowering healthcare costs for employers and employees; and he’s got numerous examples to support those claims. There is no question that the solutions he proposes are disruptive to the status quo. But, rather than view them as disruptive, we can learn from these successful models and deploy the proven blueprints that he and his colleagues at Health Rosetta have catalogued and created.
One thing is abundantly clear. The American healthcare system is not working for the vast majority of employed Americans. Dave’s facts and statistics are disturbing. What he reveals is that escalating healthcare costs are levying a hidden tax that is destroying the economic health and well-being of working American families. It’s a striking reframing of the problem that makes it very personal and very real. Once we understand this, one wonders why more emplo
Episode #110 - Straight Talk on Virtual Care, with Tom Hale MD
Friends & Colleagues,
There are a few healthcare delivery enablers which will catalyze the transformation of healthcare delivery over the coming years. In our dialogue today, we’ll be focusing on one of them - virtual care. Our guest this week has spent years directly leading the charge in virtual healthcare redesign and deployment.
Dr. Tom Hale is the Chief Medical Officer of VirtuSense where he and his colleagues are using virtual care to build value-based services for ACOs, MAs, and other at-risk models. Prior to this role, Dr. Hale pioneered the development of telemedicine and virtual care at Mercy Health. Under his leadership, Mercy telehealth services launched the world’s first virtual care center, Mercy Virtual. Prior to that, he led a 350-member multi-specialty organization as the President of Mercy Medical Group.
In this episode, Dr. Hale and I will touch on:
Some insights as to how Mercy Health developed its world renown Virtual Care services and the amazing outcomes they achieved.
Examples of AI-enabled monitoring technologies that VirtuSense has created, such as one that reduces falls by 50 to 70% in the home and in hospital rooms.
Common missteps that healthcare organizations make in deploying virtual care.
Tom’s belief that success in virtual care is largely about people and process; requiring more than just an overlay, but instead an overall redesign of clinical and business models.
Dr. Hale provides us with a very pragmatic understanding of the benefits of virtual care. He busts the myth that virtual care is merely a video substitute for a supposedly superior in-person visit. He proposes that virtual care redesign is actually far superior to the traditional approach of in-person healthcare encounters. I love his metaphor comparing traditional care to a series of ‘snapshots’ that provide disconnected, infrequent and lagging representations of a patients’ health; which is in sharp contrast to virtual care with its AI-enabled, remote monitoring and rapid responsiveness, which provides a continuous ‘movie’ of the patient's health - continuous, connected and contextual.
Dr. Hale also points out that virtual care increases access to care; and through standardization and automation, it can reduce harmful variation of care - all leading to improved outcomes and lower total costs. He backs these claims with data. The reduction of falls was significant, as well as the 60% reduction in healthcare costs that he and his colleagues achieved by placing simple remote monitoring technology and iPad’s into patients' homes. Another fascinating revelation was how AI-enabled software can detect the onset of sepsis or the worsening of chronic disease long before they become apparent through our current monitoring. An example of this is the increasing variability in heart rate that precedes the onset of heart failure by days, allowing providers to more proactively respond to and prevent ED visits and hospitalizations.
I really appreciate Tom’s thoughts regarding the impact of virtual care on the Social Determinants of Health and vulnerable populations: “Virtual care increases access to [proactive preventive] care. It decreases harmful variation. It removes the geographic barriers to care. It brings the best of the best to everybody. How can it not help the poor and underserved populations?”
And I hope his final message in this podcast makes it to the ears of policy makers and payers. “Virtual Care will increase access and decrease variation in care, and you’ll get lower costs and higher quality. But, for that to happen, we need you to decrease the regulatory barriers, and prove and support the economics around virtual care that brings value to patients.”
Until Next Time, Be Well
Zeev Neuwirth, MD
Illuminating, insightful and actionable! 🙌
Whether you’re well established as a healthcare innovator, or just getting started as a catalyst for changing the status quo - this is a must-listen podcast for you! Dr. Zeev does an incredible job leading conversations that cover a huge breadth of topics related to the ins and outs of building a thriving healthcare ecosystem - from leaders who’ve actually led successful innovation and outcomes themselves. Highly recommend listening and subscribing!
A must for health care leaders and front line clinicians