Healthcare is Hard: A Podcast for Insiders LRVHealth

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.

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.