Latest / CareTalk: Healthcare. Unfiltered. / Why US Healthcare is Fundamentally Broken w/ Zeev Neuwirth, Rezilient Health

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Why US Healthcare is Fundamentally Broken w/ Zeev Neuwirth, Rezilient Health · CareTalk: Healthcare. Unfiltered.

• 0:00
  David: Primary care is dying in America.
• 0:02
  David: Administrative costs are swallowing, clinical dollars, and employer-based healthcare, which covers more than half of Americans, is broken in ways that most people can't see.
• 0:13
  David: So what does real transformation actually look like and who's brave enough to build it?
• 0:24
  David: Hi everyone.
• 0:25
  David: I'm David Williams, president of Strategy consulting firm, health Business Group, and host of the Health Biz Podcast, where I interview top healthcare leaders about their lives and careers.
• 0:34
  David: My guest today is Dr. Zeev Neuwirth.
• 0:36
  David: He's a physician healthcare executive author of two acclaimed books on healthcare transformation.
• 0:42
  David: He's host of the award-winning podcast, creating a new healthcare, and he is now head of strategic partnerships at Resilient Health with over 30 years spanning frontline clinical practice.
• 0:52
  David: Health system leadership, and a career dedicated to reimagining how care is structured and delivered.
• 0:57
  David: Zeev is one of the most original and outspoken voices in the industry.
• 1:02
  David: Zeev, welcome to the Health Biz Podcast.
• 1:05
  Dr. Zeev: David, a pleasure to be here.
• 1:06
  Dr. Zeev: Thank you for that generous introduction.
• 1:08
  David: No, it's good.
• 1:09
  David: You know, sometimes when people tell'em, you know, they start with an introduction like that, I'm like, well, I don't, let's just end the podcast now.
• 1:14
  David: 'cause I don't know if I could live up to that.
• 1:15
  David: But in your case, I know that you can.
• 1:17
  David: So
• 1:18
  Dr. Zeev: that's funny.
• 1:19
  David: So, you know, you spent say 30 years inside healthcare, you know, all variety of, of of situations.
• 1:25
  David: And I'm wondering, when did you first realize that the system wasn't just imperfect, like any system, but really fundamentally broken?
• 1:33
  Dr. Zeev: Yeah.
• 1:33
  Dr. Zeev: Um, so for me, I had a sort of an existential moment about a dozen years ago.
• 1:40
  Dr. Zeev: I was, uh.
• 1:42
  Dr. Zeev: In the hospital system, uh, you know, as an executive and, uh, you know, had already practiced for, you know, close to 20 years as a primary care physician and then was a sort of a manager.
• 1:54
  Dr. Zeev: And then, uh, moved into sort of the executive mode running, uh, a fairly large portion of a hospital system in terms of ambulatory care, outpatient care, population health.
• 2:04
  Dr. Zeev: And I was looking at the numbers and I realized actually the real moment came, I was in a meeting with a bunch of other doctors and, and, and what we used to call suits and white coats and um, and we were talking about access and how access was really poor.
• 2:23
  Dr. Zeev: And I just sort of had this kind of, kind of just pause where, you know, kind of out of body experience almost, where I was like, wait a minute, wait a minute.
• 2:33
  Dr. Zeev: I remember the same exact conversation five years ago in this same office with a similar group of white coats and, uh, and, and, and, and suits.
• 2:43
  Dr. Zeev: And I, I sort of got a little kind of diaphoretic, you know, I got a little sweaty thinking about it, and then I thought, wait a minute, wait a minute.
• 2:51
  Dr. Zeev: I remember the same exact conversation 10 years ago back in Boston with a different group of doctors and executives talking about the same problem with the same solutions that were gonna go nowhere.
• 3:05
  Dr. Zeev: And I started to think about, well, you know, look at what we've done as a, as a country, you know, the cost of healthcare.
• 3:13
  Dr. Zeev: Astronomical getting worse.
• 3:15
  Dr. Zeev: Much, much worse than it was, you know, when I started.
• 3:19
  Dr. Zeev: Access is no better to care.
• 3:21
  Dr. Zeev: Convenience is no better.
• 3:23
  Dr. Zeev: You know, back in 1999, 2000, I was in Boston with Don Berwick and the IHI, the Institute of Healthcare Improvement.
• 3:29
  Dr. Zeev: And you know, the crossing the quality chasm came out and we were like all giddy.
• 3:34
  Dr. Zeev: Like, here we are.
• 3:35
  Dr. Zeev: We've got the data and the digital and the EMR and population health and we're gonna cross that quality chasm and we're gonna make healthcare in America.
• 3:42
  Dr. Zeev: Great.
• 3:44
  Dr. Zeev: 2000, that's 25 years ago.
• 3:47
  Dr. Zeev: A quarter of a century later, we have not even begun to cross the quality chasm.
• 3:54
  Dr. Zeev: And this is not opinion.
• 3:55
  Dr. Zeev: This is data, and this is facts.
• 3:57
  Dr. Zeev: And when you talk to people who really understand it.
• 3:59
  Dr. Zeev: I mean, I'll tell you on a very personal level, you know, I trained at the, uh, I did a master's at the Harvard School of Public Health where I've, uh, subsequently taught.
• 4:08
  Dr. Zeev: And, um, you know, and when I talked to my professors, when I was there as a graduate student, I was already a physician, already an executive.
• 4:15
  Dr. Zeev: I did a master's, uh, executive master's program there, and I would talk to the professors there and they would tell me things like, yeah, when we go into the hospital.
• 4:23
  Dr. Zeev: I don't leave my spouse alone.
• 4:25
  Dr. Zeev: I literally won't leave their bedside.
• 4:27
  Dr. Zeev: 'cause I know the data on, on hospital, uh, you know, uh, uh, uh, mistakes and errors.
• 4:33
  Dr. Zeev: I know the system.
• 4:35
  Dr. Zeev: Um, and, you know, and you know, again, so this is at a macro level, you know, this is really tragic.
• 4:42
  Dr. Zeev: Um, at a micro level, at the human level.
• 4:44
  Dr. Zeev: At the family level.
• 4:45
  Dr. Zeev: This is just, you know, I mean, it's unimaginable that a country this great.
• 4:49
  Dr. Zeev: And by the way.
• 4:50
  Dr. Zeev: I just wanna be very clear, David, this is not a knock on the at all criticism of the doctors, nurses, PAs, nps, uh, staff professionals, clinicians, all the administrators, all the folks in healthcare.
• 5:03
  Dr. Zeev: And I've been in this game for now nearly 40 years, and I'll tell you something, I have just.
• 5:08
  Dr. Zeev: Unbelievable admiration.
• 5:09
  Dr. Zeev: And I mean that so sincerely.
• 5:11
  Dr. Zeev: I mean, the people I meet in healthcare, they are hardworking.
• 5:14
  Dr. Zeev: They are smart, they are expert, they're professional.
• 5:17
  Dr. Zeev: I mean, I literally, I'm gonna be honest with you, everyone I meet in healthcare, I think, oh my God, they're so smart.
• 5:21
  Dr. Zeev: I wish I was that smart.
• 5:22
  Dr. Zeev: And they're so passionate and they wanna do the right thing.
• 5:25
  Dr. Zeev: And we have more money than, you know, we're the third largest.
• 5:28
  Dr. Zeev: If we were an economy, the third largest country in the world, our healthcare system.
• 5:32
  Dr. Zeev: All that amazing input and the outcome is miserable.
• 5:36
  Dr. Zeev: And in part it's because I think we've lost our way.
• 5:40
  Dr. Zeev: You know?
• 5:40
  Dr. Zeev: Uh, the industry is growing by leaps and bounds.
• 5:43
  Dr. Zeev: It's, you know, there's more money in it that anyone could know what to do with.
• 5:47
  Dr. Zeev: Um, and yet the health of the country is declining.
• 5:51
  Dr. Zeev: And again, we are, when you compare.
• 5:54
  Dr. Zeev: Lifespan and healthy lifespan.
• 5:57
  Dr. Zeev: So the number of years you live healthy compared to every other country we're where healthy lifespan we're 80th, we rank 80th in the world, 80th.
• 6:06
  Dr. Zeev: Um, and so I, I just, you know, we, we have to, and so the question is, okay, I hear that.
• 6:12
  Dr. Zeev: But the question is, so, so what we can, what can we do?
• 6:15
  Dr. Zeev: And the
• 6:16
  David: answer is, yeah.
• 6:16
  David: So I would say, alright, well hold on the, yeah, hold on the answer for a second.
• 6:19
  David: So, you know, so you, so you, you react to this by coming up with the answer and trying to implement that.
• 6:23
  David: I reacted to it by, uh, starting a cybersecurity company on the side.
• 6:26
  David: 'cause at least we can, you know, we can show some achievements.
• 6:29
  David: But, you know, you're exactly right, of course about, uh, you know, going into the hospital.
• 6:32
  David: I wrote a blog post way back that said.
• 6:34
  David: Going to the hospital, BYO md, like you need to bring your own doctor.
• 6:38
  David: That when we go to the hospital in my family, I have a family member who's a physician and we make sure that he comes or is at least on the phone.
• 6:46
  David: This happened just the other day.
• 6:47
  David: Um, you actually need to do that.
• 6:49
  David: And it's sort of like, you know, don't go to the hospital alone unless you're planning to die there.
• 6:52
  David: And it's not because.
• 6:54
  David: We don't have enough resources or enough patients.
• 6:56
  David: I did actually have Don Berwick on as a guest, uh, here when he was running for governor of Massachusetts, I interviewed all nine candidates for, for governor.
• 7:03
  David: And I remember one of the things he said about cost.
• 7:05
  David: This was at the time, by the way, of the new, uh, hepatitis, uh, c treatments that were, that were coming on mm-hmm.
• 7:11
  David: The market.
• 7:11
  David: And I said, how are we gonna afford that?
• 7:13
  David: And he says, what we gotta do is find a way to stop spending money on a bunch of stuff that's not worth anything, so that we can make room for those that are.
• 7:20
  David: But I think we're still spending on both.
• 7:22
  Dr. Zeev: Yeah.
• 7:22
  Dr. Zeev: And you know, I, I wanna be clear, I don't wanna, I don't wanna, you know, critique or criticize the hospital systems.
• 7:29
  Dr. Zeev: 'cause the hospitals do amazing things.
• 7:31
  Dr. Zeev: I'm a huge fan of hospitals.
• 7:33
  Dr. Zeev: I actually do think that we have to work with hospitals rather than, than dis intermediate them and support them.
• 7:40
  Dr. Zeev: I mean, this is just, they're just one manifestation, one puzzle piece of the puzzle.
• 7:45
  Dr. Zeev: Um, I mean, I could turn to, you know, to outpatient medicine too, I mean.
• 7:49
  Dr. Zeev: Why is it that, you know, 40, 50% of the country has hypertension?
• 7:53
  Dr. Zeev: 80% of that is not controlled.
• 7:55
  Dr. Zeev: I mean.
• 7:55
  Dr. Zeev: What are we doing?
• 7:57
  Dr. Zeev: Right?
• 7:57
  Dr. Zeev: I mean, um, diabetes, the majority of it is not controlled.
• 8:00
  Dr. Zeev: I mean, uh, obesity.
• 8:03
  Dr. Zeev: So it's not just the hospital.
• 8:04
  Dr. Zeev: The hospital is just one piece of a, a larger system that, you know, I would say is, is somewhat to, I think what you are getting at is the bit misguided.
• 8:13
  Dr. Zeev: Um, and I can, I can dive into what I mean by that.
• 8:16
  David: Sounds good.
• 8:17
  David: Well, I cut you off right when you said the answer is.
• 8:19
  David: I feel it's like one of those movies.
• 8:20
  David: It's like maybe there isn't an answer, but.
• 8:22
  David: You know, let's, let's hear about your answer.
• 8:24
  David: And, and also I'm interested why the focus on employer-based healthcare, whereas, you know, like often people say, well, you know, the government is the one that's making all the policies.
• 8:34
  David: So I, I'm, I'm intrigued by that employer-based focus too.
• 8:39
  Dr. Zeev: So the solution, uh, is, is a high level one.
• 8:43
  Dr. Zeev: 'cause we, you know, we could, you know, spend some time getting into some big ticket items and details.
• 8:48
  Dr. Zeev: But, um, and I'll, I'll give you a couple.
• 8:52
  Dr. Zeev: When you have tried something for 40, 50, 60 years and it's not working and you keep on trying and trying, and you say, well, if I just throw more money at it, or if I throw more technology at it.
• 9:04
  Dr. Zeev: Um, before I throw a more science at it, you keep on trying that and over and over again in different permutations.
• 9:09
  Dr. Zeev: Now it's, it's ai.
• 9:11
  Dr. Zeev: You know, before that it was digital technology.
• 9:15
  Dr. Zeev: Even before that it was data.
• 9:16
  Dr. Zeev: And before that it was the electronic medical record system.
• 9:19
  Dr. Zeev: I mean, you know, again, the, the value of being in this game for, for so long as I have, I've seen this story, I've seen this play every, you know, this is like the sixth time and, you know, so the simple answer is do anything else but what you're doing.
• 9:33
  Dr. Zeev: Do something different.
• 9:35
  Dr. Zeev: I mean, it's not, it's, it's basic, basic wisdom.
• 9:38
  Dr. Zeev: If what you've been doing is not working, don't do it better.
• 9:41
  Dr. Zeev: Don't do it more.
• 9:43
  Dr. Zeev: Do it differently.
• 9:44
  Dr. Zeev: And so, a very, very concrete example, I think, you know, kind of a little bit of what you were going to is like, we spend 5% of, of healthcare dollars in this country on primary care.
• 9:55
  Dr. Zeev: Okay?
• 9:56
  Dr. Zeev: 5%. Um, we know.
• 9:59
  Dr. Zeev: Most chronic disease, 80% of chronic disease can be mitigated, uh, reversed, radically reduced by preventive, proactive primary care.
• 10:09
  Dr. Zeev: So why aren't we spending more money?
• 10:11
  Dr. Zeev: Other countries spend two to three times that amount, relatively speaking on primary care.
• 10:16
  Dr. Zeev: Um.
• 10:18
  Dr. Zeev: We've really denuded primary care in this country and it's going away.
• 10:23
  Dr. Zeev: As you said in the introduction, it's dying in the vine.
• 10:25
  Dr. Zeev: When I talk to the experts around the country, primary care essentially is on life support.
• 10:29
  Dr. Zeev: Right now it's in the ICU and it's dying.
• 10:31
  Dr. Zeev: And I'll tell you something, uh, when that goes.
• 10:34
  Dr. Zeev: Uh, you, you know, watch out.
• 10:37
  Dr. Zeev: The system's gonna implode because, you know, relying on specialists, and again, I, I love specialists and I appreciate what they do.
• 10:44
  Dr. Zeev: Um, some of my best friends are specialists, important, critically important work, but we have to rightsize this system.
• 10:52
  David: So let's talk about primary care.
• 10:53
  David: So we, I, I ran a, um.
• 10:56
  David: Uh, I, I was doing a panel discussion about primary care for a nonprofit that I, that I volunteer for, and I was actually looking for people in primary care, and it's mostly like, you know, a couple of older people.
• 11:06
  David: And we found somebody that's a, a med student who was planning to go into primary care.
• 11:10
  David: And so I said, well, how one way we're gonna be able to get people to come to this event, as I'll say, Hey.
• 11:15
  David: You know, the door prize is at an appointment with a primary care physician, which is hard to get even in Boston or especially in Boston.
• 11:21
  David: Mm-hmm.
• 11:21
  David: And then also the ground rule is don't tell this guy not to go into primary care, because we may need some people to do it, but I mean, it's one thing to say we, we should be spending more on it.
• 11:31
  David: But it sounds like, you know, it's in the ICU, it's dying on the vine.
• 11:35
  David: I mean, what's killing it and what, like, why is that happening?
• 11:39
  Dr. Zeev: Well, um.
• 11:40
  Dr. Zeev: We, you know, primary care essentially has become a feeder for specialties and for the hospital.
• 11:46
  Dr. Zeev: When, you know, primary care providers are, are required to force, to incented, to see a patient every 15 or 20 minutes, you know, you barely could get, okay, you've got hypertension, diabetes, high cholesterol, whatever.
• 12:02
  Dr. Zeev: I'm just gonna write a script and give you a prescription and you know, out the door.
• 12:07
  Dr. Zeev: Um, and so, you know, uh, primary care also, you, you know, primary care is sort of like, um, you know, it's kind of the garbage dump of healthcare.
• 12:17
  Dr. Zeev: Everything is sent to primary care, right?
• 12:19
  Dr. Zeev: The specialists don't wanna deal with a lot of stuff.
• 12:21
  Dr. Zeev: Now, again.
• 12:22
  Dr. Zeev: I, I, I, I will tell you that a lot of my specialty friends do a lot of extra work, but primary care, you know, you, you come home after a full day of seeing patients and you probably have two or three hours, right?
• 12:32
  Dr. Zeev: This is documented in the literature, at least two or three hours of work just to take care of the work you did that day.
• 12:37
  Dr. Zeev: And then you'd like to actually prepare for tomorrow to see those patients.
• 12:40
  Dr. Zeev: So when they walk in, it's just like, nah, you know, I'm looking at the note trying to figure out who you are.
• 12:44
  Dr. Zeev: I mean, essentially, you know, and this has been sort of calculated and discussed in the literature, the medical literature, you probably, if you're a good primary care doctor, you probably are working 18 to 20 hours a day.
• 12:55
  Dr. Zeev: Um, that is obviously impossible for anyone.
• 12:59
  Dr. Zeev: But I'll tell you, I know doctors for years who literally take vacations to do nothing else but.
• 13:05
  Dr. Zeev: Catch up on their paperwork.
• 13:06
  Dr. Zeev: This is insane.
• 13:08
  Dr. Zeev: Um, it's abusive.
• 13:09
  Dr. Zeev: Um, you talk about the burnout in primary care, which is over half, the doctors are burnt out.
• 13:13
  Dr. Zeev: They're not burnt out because of seeing patients, they're burnt out because they don't, they're not actually doing what they wanted to do, which is actually take care of people.
• 13:22
  Dr. Zeev: You need primary care is a relat.
• 13:24
  Dr. Zeev: Faced profession.
• 13:26
  Dr. Zeev: If you're a surgeon, it's fine.
• 13:27
  Dr. Zeev: If you barely know your patient, it's really, it's fine.
• 13:30
  Dr. Zeev: You, you, you, you know, you make sure you're doing this is the right patient, getting the right procedure.
• 13:35
  Dr. Zeev: You make sure they're prepared for the surgery, but literally what you do, the patient is unconscious.
• 13:40
  Dr. Zeev: They're, they're knocked out, they're asleep.
• 13:41
  Dr. Zeev: You can't do that with, with primary care.
• 13:43
  Dr. Zeev: Primary care is a relationship based thing.
• 13:46
  Dr. Zeev: I think we've really lost sight of the fact that it's not transactional.
• 13:51
  Dr. Zeev: If, if all it is is transactional, it's like going to a machine and saying, I've got this, and now comes a medication.
• 13:56
  Dr. Zeev: Uh, you know.
• 13:57
  Dr. Zeev: That doesn't work.
• 13:58
  Dr. Zeev: We know it doesn't work because we're doing it now.
• 14:01
  Dr. Zeev: I mean, people, people don't trust doctors.
• 14:03
  Dr. Zeev: They don't, uh, take the medications they're supposed to take.
• 14:06
  Dr. Zeev: Um, the doctors don't have the time to create those relationships, and so we're really shooting ourselves in the foot.
• 14:11
  Dr. Zeev: You know, this is, this is the Ben Franklin thing, you know?
• 14:14
  Dr. Zeev: Um.
• 14:15
  Dr. Zeev: Stitch in time saves nine.
• 14:16
  Dr. Zeev: I mean, we're really, we're really spending much, much more money on, on the, on the, on the downstream because we're not spending a few pennies upstream.
• 14:24
  Dr. Zeev: And, um, and so we really have to right-size that.
• 14:27
  Dr. Zeev: And you know what I'm doing now, you know, you know, you talked about direct primary care and, and, and direct to employer care.
• 14:34
  Dr. Zeev: Um.
• 14:35
  Dr. Zeev: It kind of goes back to what I was saying before, we have to do something different.
• 14:39
  David: So, as you said, you know, you and and others have think, have realized that this primary care thing just just doesn't make any.
• 14:45
  David: Real sense what we're doing and have not just thrown your hands up in the air and said There's nothing to do about it.
• 14:50
  David: Say like, what, what should we do about it?
• 14:52
  David: And we do hear about these models.
• 14:53
  David: So what I've seen, uh, in my own experience mm-hmm.
• 14:56
  David: Is I'll have a physician and then they'll say, this is insane.
• 15:00
  David: Uh, I'm just gonna start a concierge practice.
• 15:02
  David: Now, of course, what that does for them is it gets rid of this problem that, like, that they could take vacation and maybe they could go to the beach and take a few days off as opposed to the paperwork and say, I see a fewer patients.
• 15:12
  David: I make the same or more money and I get to take care of them, that's more satisfying.
• 15:15
  David: Now, of course, from a population standpoint, if they go from a panel of 3000 to 300, then they've just thrown everybody else out there.
• 15:22
  David: So that is not a good systemic solution.
• 15:25
  David: And so things to me sound, uh, and I wanna hear about them direct to employer care, direct primary care that I think don't have that problem of just reducing capacity overall in the, in the system.
• 15:37
  David: What are, what are those models and, um, why, why are they promising?
• 15:42
  Dr. Zeev: Yeah.
• 15:42
  Dr. Zeev: And you know, I, you're right about concierge it, it's, it's the right idea in terms of.
• 15:49
  Dr. Zeev: I'm gonna have a, a smaller number of patients.
• 15:52
  Dr. Zeev: I'm gonna charge them a lot of money so I can actually have a practice.
• 15:55
  Dr. Zeev: I can sustain a practice, um, financially, and I get the time to see my patients and, and, you know, you can actually create a practice in concierge care charging a, you know.
• 16:06
  Dr. Zeev: Uh, you know, a a a couple to a few hundred dollars per, per member per month.
• 16:11
  Dr. Zeev: You can, you can, you can see four or 500, 600 patients and, and really be like, you know, their doctor.
• 16:17
  Dr. Zeev: It's incredibly satisfying for the physician.
• 16:20
  Dr. Zeev: Incredibly satisfying for the patient.
• 16:22
  Dr. Zeev: The problem is, to your point, first of all, how many people can afford to pay that?
• 16:26
  Dr. Zeev: I can't, um, quite honestly, um, most Americans, 99% of Americans cannot afford that kind of, uh, you know, concierge level care.
• 16:34
  Dr. Zeev: So how do you create that sort of situation in an affordable way?
• 16:39
  Dr. Zeev: And so one of the ways is sort of this direct contracting, um, and now it's, it's, it's being done.
• 16:45
  Dr. Zeev: By the way, most people are not even aware how big direct contracting is in this country.
• 16:48
  Dr. Zeev: At this point.
• 16:49
  Dr. Zeev: 40% of large employers have been contracting.
• 16:52
  Dr. Zeev: Directly.
• 16:53
  Dr. Zeev: So they, they bypass the insurance company, which by the way, a lot of money is in the middlemen.
• 16:58
  Dr. Zeev: They cut out the middlemen, um, and they go either directly to a provider or provider group, or directly to a hospital.
• 17:05
  Dr. Zeev: And this is, this is happening, this groundswell is huge.
• 17:09
  Dr. Zeev: Um, whether it's to, to, to surgical specialties to hospitals or to providers like primary care providers.
• 17:16
  Dr. Zeev: So, uh, the idea is, you know, you contract directly, you reduce the costs.
• 17:21
  Dr. Zeev: And, um, by contracting with a population.
• 17:24
  Dr. Zeev: So let's say.
• 17:25
  Dr. Zeev: An employer has a thousand or 2000 or 5,000 or 20,000, you contract for that population.
• 17:31
  Dr. Zeev: You become the provider.
• 17:32
  Dr. Zeev: And again, you know, with 20,000, obviously you're not gonna have one provider.
• 17:35
  Dr. Zeev: You'll have a team of providers, but you actually contract directly with them.
• 17:39
  Dr. Zeev: You set up a payment model that allows that direct primary care to spend the time and build the relationships that are actually required for the outcomes you want, which are, you know, essentially good health outcomes.
• 17:54
  David: Got it.
• 17:55
  David: Now let's talk about how technology comes into that.
• 17:58
  David: 'cause you just mentioned a few things between data EMR, the personal health record for, for a while, and now we're up to, uh, to ai.
• 18:07
  David: Now, it, it is the case that, you know, there's, there's some role for technology.
• 18:12
  David: Mm-hmm.
• 18:12
  David: It's clearly not a panacea.
• 18:14
  David: What, what is your view on what technology can do and can't do, you know, at this moment or, or looking forward for a transformation?
• 18:22
  Dr. Zeev: Yeah.
• 18:22
  Dr. Zeev: And, and, and I, I just wanna be clear, um, I, I think technology is critically important and absolutely necessary.
• 18:31
  Dr. Zeev: Um, technology in my mind is never the solution, but it is a profound enabler.
• 18:38
  Dr. Zeev: And so if we ever think it's a solution, I think we're just fooling ourselves.
• 18:42
  Dr. Zeev: But it is a critical and necessary, uh, enabling fact.
• 18:46
  Dr. Zeev: In, in the second book I talked about, you know, technology and business model transformation are the two powerful enablers.
• 18:56
  Dr. Zeev: And I think if you're, if you're not.
• 18:58
  Dr. Zeev: Transforming your business model and you're not using state of art technology, you're not gonna be successful in the future of, of, of, of healthcare, no matter who you are.
• 19:06
  Dr. Zeev: So, um, having said that, a very concrete example is, uh, now, uh, the ability to have, uh, AI scribes so.
• 19:16
  Dr. Zeev: Before you know the physician, we all know this, I think anyone who's ever seen a doctor or anyone who's in clinical care knows this, you walk into the room, the provider's actually facing the screen.
• 19:26
  Dr. Zeev: They've got the keyboard, their, their fingers are planted on the keyboard as opposed to a. Looking at you and talking with you and touching you.
• 19:35
  Dr. Zeev: Um, because they have to input all the data into the electronic medical record, which if you think about it, think about this.
• 19:41
  Dr. Zeev: You have a person who's not only gone, gone to high school and college, but they've gone to medical school and then they've done a residency on top of that, um, post college training anywhere from three to 10 years after college, and now you have them spending.
• 19:58
  Dr. Zeev: 40% of their time doing data entry.
• 20:01
  Dr. Zeev: Seriously.
• 20:01
  Dr. Zeev: I mean, that's what you're paying your incredibly, uh, sophisticated and, and experienced and costly, uh, physicians and, and, and, and others and, and you know, to do, it's absolutely ridiculous.
• 20:13
  Dr. Zeev: Now with AI scribes, literally the provider doesn't have to do any of that.
• 20:17
  Dr. Zeev: The scribe will automatically be putting it in, in fact, probably better than the physician in putting that data in, bringing in other data to actually inform the physician, um, prepare the physician for the visit, remind the physician, you know, of here's, you know, um, literally, uh, saying, here's the possibility.
• 20:32
  Dr. Zeev: The patient just said a whole bunch of things.
• 20:33
  Dr. Zeev: It could be A, B, C, or D. Um, and I think we should recommend these tests.
• 20:37
  Dr. Zeev: I mean.
• 20:38
  Dr. Zeev: That kind of enablement.
• 20:40
  Dr. Zeev: And you know, a lot of doctors worry, oh my God, AI is stealing my, my business.
• 20:44
  Dr. Zeev: AI is not stealing your business.
• 20:45
  Dr. Zeev: AI is going to empower you to be better at what you do and uh, and actually be able to do it for more people.
• 20:52
  Dr. Zeev: So, and, and so that's one concrete example.
• 20:55
  Dr. Zeev: It's actually happening now.
• 20:57
  Dr. Zeev: It's actually, you know.
• 20:59
  Dr. Zeev: Five years ago, or even three years ago, the idea of an AI scribe was sort of like, wow, this is new, et cetera.
• 21:05
  Dr. Zeev: Now it's table stakes.
• 21:06
  Dr. Zeev: If you're not doing this, you're behind.
• 21:08
  Dr. Zeev: Right?
• 21:08
  Dr. Zeev: And that happened literally in three years.
• 21:11
  David: Let's talk a little bit about value-based care, because that's been kind of the mantra.
• 21:15
  David: You know, we, we just pay people for the hours and work that's done and we should pay for performance.
• 21:19
  David: And then we can tie in the, you know, the whole medical loss ratio to the physicians are doing, and I'm thinking about.
• 21:25
  David: Like, in a way Yeah, that makes sense.
• 21:27
  David: But also in other areas of the economy, like when, when I go to the gas station, I pay, you know, per gallon, I pay a lot of things per hour if someone's working on, you know, if I had a higher handyman for my house or, or even a lawyer.
• 21:38
  David: Mm-hmm.
• 21:38
  David: So what is why in healthcare are we, is value-based care getting so much attention and does it, does it, does it work?
• 21:50
  Dr. Zeev: It's a really, really great question and I think, um, a little complicated.
• 21:56
  Dr. Zeev: Um, I do think, you know, if you look at what's happening now with some of the payment, what's been happening for the past 10 years, since, uh, you know, uh, uh, since, you know, since the Obama Act and Obamacare, um.
• 22:12
  Dr. Zeev: With, uh, the Center for Medicaid and Medicare Innovation Center, CMMI, they've been testing out a lot of payment models.
• 22:19
  Dr. Zeev: Um, I, I, I think we're, we're now.
• 22:22
  Dr. Zeev: Surprisingly, in some ways with this administration, we're actually seeing some pretty, uh, really, really good payment models, largely focused on what they call, uh, outcomes aligned payment, uh, os OAP and for instance, there's this access model, advanced, um, uh, chronic care, um, uh, with, with sustainable, uh, scalable solutions.
• 22:46
  Dr. Zeev: And they're basically paying now.
• 22:48
  Dr. Zeev: For outcomes.
• 22:49
  Dr. Zeev: So for instance, like around high blood pressure, if you reach a certain level, and I forget, it's like a one 40 over 80.
• 22:56
  Dr. Zeev: You get a certain amount of money.
• 22:57
  Dr. Zeev: But if you actually get your population, uh, down to appropriate, you know, one 20 or 80, you get more money.
• 23:03
  Dr. Zeev: So it's now like, we'll pay you.
• 23:05
  Dr. Zeev: For outcomes.
• 23:06
  Dr. Zeev: And I think that direction, uh, another is the teams model looking at surgical bundles and, and, and, and so outcomes as well.
• 23:14
  Dr. Zeev: So I think this notion of so-called value-based care, which can mean a lot of different things, I think I would start to agree with where I see the language moving more about outcomes aligned payment.
• 23:27
  Dr. Zeev: Um, and you know, having said that.
• 23:30
  Dr. Zeev: You know, another thing which I don't think is, is recognized enough, and I think this is why we were talking about direct contracting.
• 23:40
  Dr. Zeev: I, I think, I think we're misguided in terms of the whole insurance model.
• 23:46
  Dr. Zeev: Primary care, basic primary care is not a. It's not an insurable thing.
• 23:53
  Dr. Zeev: It shouldn't be insured, right?
• 23:54
  Dr. Zeev: I mean, insurance was built.
• 23:56
  Dr. Zeev: The whole idea of insurance was if something, uh, is, you know, has a very, very small likelihood of happening, less than 5%, you know, sort of life insurance, right?
• 24:05
  Dr. Zeev: I mean, hopefully your chance of dying is, is, is rare, right?
• 24:09
  Dr. Zeev: Um, house insurance, ho hopefully your chances of being struck by lightning or something happened is rare.
• 24:14
  Dr. Zeev: It's less than 5%.
• 24:16
  Dr. Zeev: There mathematically it makes sense to ensure, because it's rarely gonna happen.
• 24:22
  Dr. Zeev: You would not insure.
• 24:23
  Dr. Zeev: Let's say, do you have gasoline insurance?
• 24:25
  David: I was gonna
• 24:26
  Dr. Zeev: say,
• 24:26
  David: right, like I'm not gonna insure for my oil change or my monthly electric bill, but if my house catches on fire or I total my car, different matter.
• 24:33
  David: Right?
• 24:33
  Dr. Zeev: Right.
• 24:34
  Dr. Zeev: Why would you insure primary care?
• 24:36
  Dr. Zeev: You know, you need primary care.
• 24:39
  Dr. Zeev: It's not like a Do I need it once in a while?
• 24:40
  Dr. Zeev: No, you actually, I mean, you do want preventive, proactive, primary care.
• 24:44
  Dr. Zeev: We know when people, a population, a community, an employer has primary care, people's health improves.
• 24:52
  Dr. Zeev: Um, and the cost of care goes down.
• 24:53
  Dr. Zeev: We know that it's been demonstrated over and over again for decades.
• 24:57
  Dr. Zeev: So take it out of the insurance pool.
• 24:59
  Dr. Zeev: Pay for primary care, like you pay for gasoline, like you pay for, like you're saying, your your heating bills.
• 25:05
  Dr. Zeev: You know you're gonna use it in the winter.
• 25:06
  Dr. Zeev: You don't insure against heating.
• 25:08
  Dr. Zeev: You just pay it on a monthly basis.
• 25:10
  Dr. Zeev: And it's the same for primary care.
• 25:12
  Dr. Zeev: Pay that.
• 25:13
  Dr. Zeev: And you know, the truth is, as I said before, it'll pay dividends in terms of reducing the need for specialists, emergency room visits, uh, procedures down the road.
• 25:24
  Dr. Zeev: And by the way, it doesn't take that long to actually see that return.
• 25:27
  David: Got it.
• 25:28
  David: Alright, so let's expand the discussion a little bit beyond healthcare and talk about.
• 25:32
  David: Health and also beyond when we talk about technology beyond information technology to maybe some, some other types including, you know, pharmaceutical.
• 25:39
  David: So, you know, we mentioned upfront how, you know, we spend a ton on healthcare and you know, outcomes are not that good.
• 25:45
  David: People don't live that long, et cetera, and that's all true.
• 25:50
  David: It doesn't necessarily follow that.
• 25:52
  David: It's the healthcare system that's, that's causing that.
• 25:54
  David: And there's a broader, you know, kind of health and and lifestyle pieces that, that come out.
• 25:58
  David: And the goal is health.
• 25:59
  David: It's not, you know, my goal is health, not better healthcare.
• 26:02
  David: Right.
• 26:02
  David: And then on the technology side, I think where this comes in, a lot of people see it is mm-hmm.
• 26:06
  David: With the GLP ones, so mm-hmm.
• 26:08
  David: It's, you know, that's the type of technology that you can, that use and have a big impact.
• 26:12
  David: So how do you think about.
• 26:14
  David: Health versus healthcare and technology broadly?
• 26:18
  Dr. Zeev: Yeah, I, that's a really, really good question.
• 26:20
  Dr. Zeev: In fact, I was just talking to someone about the difference between healthcare and health.
• 26:25
  Dr. Zeev: Um, so, you know, I think our healthcare system is largely a reactive system.
• 26:30
  Dr. Zeev: People call it the sick care system.
• 26:32
  Dr. Zeev: Um, which by the way, I, I, I don't think that's a. Criticism.
• 26:38
  Dr. Zeev: I'm super grateful.
• 26:39
  Dr. Zeev: Yeah.
• 26:39
  Dr. Zeev: We have a great sick care system.
• 26:42
  Dr. Zeev: Um, I have family members who have it saved their lives.
• 26:46
  Dr. Zeev: Yeah.
• 26:46
  Dr. Zeev: And because the of the expertise and the technology and the hospitals and I'm beyond, beyond grateful forever.
• 26:52
  Dr. Zeev: For the sick care system.
• 26:54
  Dr. Zeev: So that's not a bad thing.
• 26:56
  Dr. Zeev: Um, but what the sick care system or so-called our healthcare system is not really good at is health, making people healthy.
• 27:05
  Dr. Zeev: Um, and we know, again, most of chronic disease.
• 27:08
  Dr. Zeev: 80% of it, 90% of it is around nutrition and, uh, lifestyle changes.
• 27:14
  Dr. Zeev: It could, it could be greatly, greatly reduced through that.
• 27:17
  Dr. Zeev: So the, the, the question is, you know, what can we do to improve our health and not just, you know, improve our illnesses and diseases, but actually prevent them or mitigate them?
• 27:27
  Dr. Zeev: And so, um, I do think that the healthcare system.
• 27:31
  Dr. Zeev: Can play a role in that.
• 27:32
  Dr. Zeev: So for example, we have primary care physicians and, and other physicians.
• 27:37
  Dr. Zeev: You don't necessarily have to be a primary care physician, but generally speaking as primary care providers who are boarded in lifestyle medicine, there's an American College of Lifestyle Medicine.
• 27:46
  Dr. Zeev: It is a evidence-based approach.
• 27:48
  Dr. Zeev: You get a board certification for it.
• 27:50
  Dr. Zeev: Um, and, uh, and these providers are trained in, in nutrition, in physical activity and stress in sleep, you know, in, in the factors that really.
• 28:00
  Dr. Zeev: They know how to coach people.
• 28:02
  Dr. Zeev: And on top of that, to your point about cost and, and getting to a population, you have to learn how to do this as a team, right?
• 28:09
  Dr. Zeev: So you have a team doing this so that the doctor is not doing everything, the doctor is doing what they do, but then you have a nutritionist and behavioral therapist and you have health coaches, et cetera, physical therapists.
• 28:20
  Dr. Zeev: So it is really a team-based sport.
• 28:22
  Dr. Zeev: And if I think we convert.
• 28:24
  Dr. Zeev: Bring in lifestyle medicine, converted to that sport.
• 28:27
  Dr. Zeev: I think the healthcare system can play a role.
• 28:31
  Dr. Zeev: And then when you ask about technology, um, you know, I think the notion of even some, you know, some of the wearables using feedback to say, okay, is Zeev, you know, I, you know, how is your sleep?
• 28:43
  Dr. Zeev: We know that sleep is huge, bigger than anything you might imagine.
• 28:46
  Dr. Zeev: You know, people are taking testosterone.
• 28:48
  Dr. Zeev: You don't need to take testosterone.
• 28:49
  Dr. Zeev: Get eight hours of sleep a night.
• 28:51
  Dr. Zeev: Yeah.
• 28:51
  Dr. Zeev: That's when your testosterone is made.
• 28:52
  Dr. Zeev: You know, um, by the way, it affects, it affects your weight, it affects your mental health.
• 28:57
  Dr. Zeev: You, you know, it actually is a, a prevention in terms of dementia.
• 29:00
  Dr. Zeev: So, but I don't know how I sleep until I actually put a device on and it tells me, oh, you know, you're, you're getting this kind of sleep or not, and then you can work on it.
• 29:08
  Dr. Zeev: So I think the marriage of bringing this sort of lifestyle medicine approach.
• 29:14
  Dr. Zeev: Combined with a team-based approach, uh, to lower the cost and get the real experts to help the providers, the physicians, um, uh, and NPS and PAs, and couple that with technology.
• 29:25
  Dr. Zeev: GLP ones and peptides are a whole other story, which I have some concerns about.
• 29:30
  David: Yeah.
• 29:31
  Dr. Zeev: And I know I'm not the only one.
• 29:32
  Dr. Zeev: Um, uh, you know, it's, um, it's, it's.
• 29:37
  Dr. Zeev: In certain cases, they're miracle drugs.
• 29:40
  Dr. Zeev: Let's not, let's be clear, right?
• 29:41
  Dr. Zeev: Um, if you have diabetes or heart disease, um, it is the, the literature is pretty clear.
• 29:47
  Dr. Zeev: I worry about the way it's being used now.
• 29:49
  Dr. Zeev: It's being used as a substitute for appropriate nutrition and appropriate exercise.
• 29:55
  Dr. Zeev: And the problem with that is that it does have side effects.
• 30:00
  Dr. Zeev: The literature right now, as far as I can tell, is saying that most people will be off of it within a year or two.
• 30:05
  Dr. Zeev: And so you've taken tremendous costs.
• 30:08
  Dr. Zeev: Someone's paying a lot for these medications.
• 30:10
  Dr. Zeev: They have side effects, um, and they cause sarcopenia loss of muscle mass.
• 30:15
  Dr. Zeev: So you find yourself two years down the road having paid a lot of money, um, now you've given up the medication, you've gained the weight back.
• 30:22
  Dr. Zeev: And you have less muscle than you had before, and you've put yourself at risk and you haven't changed your lifestyle.
• 30:27
  Dr. Zeev: And so I worry without that preventive primary care.
• 30:32
  Dr. Zeev: So I'm, I'm not against GLP ones or peptides, I'm just saying they need to be coupled with primary care, preventive, proactive, primary care.
• 30:40
  David: Sounds good.
• 30:41
  David: It sounds like that when you hear about like these lottery winners, you know, who then end up destitute, you know that that plus the GLP ones and then two years are gonna be in much worse shape than when they started.
• 30:49
  David: Well, let's send it there.
• 30:50
  David: So that's it for another episode of the Health Biz Podcast.
• 30:53
  David: My guest has been Dr. Zeev Neuwirth.
• 30:54
  David: He's a physician, author, and head of strategic partnerships at Resilient Health.
• 30:59
  David: If you like what you heard, please subscribe on your favorite podcast platform and Zeev, thank you so much for joining me today.
• 31:06
  Dr. Zeev: Thank you Dick.