Latest / Becker’s Healthcare - Clinical Leadership Podcast / Dr. Leslie Wong, Senior Medical Director of Medical Specialties at Intermountain Health

Transcript

Dr. Leslie Wong, Senior Medical Director of Medical Specialties at Intermountain Health · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  - This is Laura Dedo with the Becker's Healthcare Podcast.
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  I'm thrilled today to be joined by Dr.
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  Leslie Wong, senior Medical Director of Medical Specialties,
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  as well as Chief Kidney Health Officer
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  and Senior Medical Director of all kidney Services
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  and nephrology practices for Intermountain Health.
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  Dr. Wong, it's a pleasure to have you on the podcast today.
• 0:18
  - Yeah, thank you, Laura. Um, I'm, uh,
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  very privileged and honored to be here.
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  - Now. I'm really looking forward to our discussion.
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  I know we have a lot to talk about,
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  and there's so many exciting things happening in healthcare
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  right now, particularly at Intermountain,
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  which has always been on the forefront
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  of innovation within the healthcare delivery space.
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  But before we dive into that discussion,
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  can you tell us a little bit more
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  about yourself and your background?
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  - Yeah, absolutely.
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  So, um, you know, I, I, I have, I've got actually, uh, the,
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  the fortune of having two, uh, distinct
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  and very, um, fulfilling roles here at Intermountain.
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  So I, I lead our medical specialists, so
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  that's basically all of the medical specialties like
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  endocrinology, rheumatology, infectious disease,
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  everything except the, um, the, uh,
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  interventional like gi cardiology ones.
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  Uh, and I also, and with the original reason I was recruited
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  to Intermountain was to lead, uh,
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  efforts at improving kidney health through our system.
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  So I, I oversee, uh, the care of patients with all levels
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  of kidney disease, including on dialysis, uh,
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  but all of our nephrology practices across, um,
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  across our networks.
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  - Well, that's amazing to hear,
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  and I can imagine a really big job, um, to, to cover such a,
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  a broad area that I know Intermountain covers
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  and, um, such an important area too.
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  When you think about kidney care now, what are some
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  of the biggest issues that you're
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  following in healthcare right now?
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  - Yeah, I think it, you know, again, I I, I'm a bit biased
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  because I'm a nephrologist,
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  I'm a kidney specialist by trade.
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  Uh, but while I say what I will say from, uh, you know,
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  a lot of, um, you know, inter daily interaction and,
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  and just thinking in terms of, uh, of big picture, uh,
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  improvement of healthcare, uh, you know, I think,
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  I think prevention, uh, ident early identification,
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  prevention and, um, you know, like sustainable strategies
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  to address chronic conditions, uh, which are inclusive
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  of kidney disease.
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  Uh, but I think really encompass, uh, the big drivers of,
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  uh, you know, mortality, morbidity, and, and,
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  and pain and suffering, right?
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  Uh, diabetes, cardiovascular disease,
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  obesity, things like that.
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  And, and I think, you know, it goes part
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  and parcel with the whole idea
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  and focus right now on improving
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  value in healthcare delivery.
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  You know, how do we actually invest, uh, justify
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  and strategize around, um, you know, using our healthcare,
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  our scarce healthcare resources, right?
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  To, to reach people where they're at
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  and at a point in their, uh, in their lives where, you know,
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  we can actually prevent these costly events
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  from happening, right?
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  And prevent people from actually having
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  disease and keep them healthy.
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  I think that is the biggest issue that, um,
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  not just here in Intermountain, but across healthcare.
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  - That's such an interesting point.
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  And certainly, you know, a huge, huge challenge, uh,
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  for communities across the country
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  and in the work that you're doing.
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  Obviously, there's a lot, um, that, uh,
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  the medical community can do,
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  but a certain percentage of it as well is, uh, trying to,
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  um, change the behaviors in, you know, wellness, um,
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  activities of the community at large.
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  When you look at, um, you know, those two, I guess, spaces,
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  how do you really, are you really tackling this problem of,
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  um, trying to change behaviors
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  and really get the community more in a place
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  where you're able to, um, prevent some of the big challenges
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  that can, um, make a big,
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  big difference for people's health?
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  - No, absolutely. I mean,
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  and so looking at, at disease identification
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  and prevention from a, from a global kind
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  of societal public health view, I mean, you know,
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  there's certainly a, a great need, um,
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  and, um, a great challenge for us as, as you know,
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  the United States, um, to, um, to, to, to cha, you know,
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  to identify those, those actionable items in terms
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  of behavior, which, you know, unfortunately, a lot
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  of those things are, you know, you know,
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  we turn them social determinants of health, right?
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  Are, are sometimes beyond what we as clinicians
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  can immediately affect, uh, a change.
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  But I think just acknowledging the importance
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  of those things, uh, is, is critical.
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  Um, and I do think that there are these, um, you know,
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  people have termed it kind of, um,
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  not the social determinants of health,
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  but kind of the policy determinants of health.
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  I think those, those actually drive,
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  those actually drive our ability
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  or inability to address those.
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  I would say, um, you know, while we do want people, right,
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  not patients, but people to be more aware, engaged, um,
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  and, and, and, and active in, in,
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  in keeping themselves healthy.
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  And we know that a lot of that starts not, not in adulthood
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  or in late, you know, in middle age or, or or
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  or older age when people are actually sick.
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  But that starts like when they're adolescents
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  that starts when they're, you know, children.
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  It actually starts, you know, in the prenatal period, right?
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  We can't actually fix all that right now,
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  but I think one, one of the things we can, um, address is
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  how do we change behavior of physicians, of nurses,
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  of, um, healthcare leaders
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  and administrators so that we're all kind
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  of rowing in the same direction?
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  And, and, and you know, I think, Laura, you know,
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  I started out in private practice
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  and I, I had this very naive conception of healthcare.
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  Um, you know, coming from a, you know,
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  from an ac a busy academic medical center saying, Hey,
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  listen, if, you know, if I'm in practice on my own and,
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  and I'm not beholden to the rules of the medical center
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  or hospital, I'll be able to deliver the kind of care,
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  the kind of healthcare that I think is appropriate.
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  And boy, was that a rude awakening when I, you know, that,
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  you know, the first month in private practice when I
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  realized that, you know, the world
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  doesn't actually work that way.
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  Um, so I think, you know, in my journey through healthcare,
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  uh, through practice working in industry on a couple
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  of occasions, and then, um, you know, large, um, you know,
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  very, very, I think, uh,
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  forward thinking health systems like Cleveland Clinic
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  and Intermountain, it's really given me that perspective
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  that, that at the, at the end of the day, in order for us
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  to, to do better for our patients, to, to create
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  that awareness and, and that policy change, physicians have
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  to be front and center in, in,
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  in changing their own behavior
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  and recognizing what they need
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  to do in order to make that happen.
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  - That's great to hear it, and, you know, such a helpful
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  and important perspective
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  to have from the healthcare professional community.
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  Now, when you look ahead, what are you most excited about?
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  What makes you nervous?
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  - Well, you know, I'm excited about our, you know,
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  I think the growing, uh, not only awareness,
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  but the growing, uh, involvement that, that we as physicians
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  and we as healthcare providers have in
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  the whole value equation.
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  And, and I know that's, that, that's now kind
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  of a hackney term, right?
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  Value-based care. But,
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  but essentially, you know, if we're not able to leverage
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  a different model of payment, uh, a different reward system,
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  right, in, in healthcare, we won't be able to sustain
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  or motivate people to change.
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  So I'm excited by the fact that, you know, for example,
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  at Intermountain Health, we are, you know, 50% plus, uh, in,
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  uh, in value-based payment arrangements, which, you know,
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  it doesn't fix all
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  of those social determinants of health issues.
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  It doesn't fix all of the, um, the behavior change issues,
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  um, you know, for our providers
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  or for the people we care for,
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  but it gives us the opportunity to do so.
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  So that's what makes me really excited.
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  Um, but what makes me not excited is the fact that the, the,
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  the pace of change
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  and the amount of change, even for someone like me who's,
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  you know, really I, you know, I really try
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  to dedicate my career at, at changing healthcare delivery.
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  Um, it, it's dizzying.
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  So when, you know, when, for example,
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  the federal government has, oh, gosh, you know,
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  I think it's like 50 plus a different a CO or,
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  or alternative payment models as they used to be called, uh,
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  you know, the frontline clinician who, who,
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  who we really need to buy in and invest their time, effort
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  and, you know, you know, their, their blood sweat
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  and tears into, it's almost over.
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  It's almost over it, it's almost too overwhelming.
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  And then you've got a lot of noise, of course,
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  because, um, you know, you've got big players, uh, outside
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  of the traditional healthcare systems, you know, the Amazons
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  of the world, um, the, you know, the, the, the CVSs and,
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  and, and, you know, Walgreens, yes.
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  But now, no, you know,
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  that are really foreign into healthcare saying, Hey,
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  can we apply a lot of these things
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  that have been really successful in non-healthcare sectors
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  and make healthcare more efficient and effective?
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  Um, you know, I think there's been, I think the jury's out
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  because we've seen some great, um, success,
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  but we've also seen, um, some, some challenges.
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  And I think, I think where I, as a physician, um, you know,
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  become concerned is that, you know, with all the hype
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  and hyperbole around, you know, transforming healthcare and,
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  and disrupting healthcare, you know, who's really in it
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  for the long term, right?
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  Who's got the, who's got the will, uh,
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  or the finances to, to go
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  through the ebbs to get to the peak.
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  Does that make sense, Laura?
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  - Yeah, yeah, that makes a lot of sense.
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  You know, and it is a really fascinating way to approach,
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  um, just the healthcare landscape today,
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  because as you mentioned, you know,
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  it seems like there is huge opportunity from the traditional
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  healthcare space to figure out how
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  to do it better and, and deliver better.
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  But at the same time, there's so many complexities that,
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  you know, coming from outside of the industry and,
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  and trying to be successful within healthcare, um,
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  given the regulations, giving the just, um, how, you know,
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  important it is to communities and how necessary it is, um,
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  and everything else that goes along with the,
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  the broader healthcare ecosystem.
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  It's not easy to do
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  and just come into the industry, um, you know, brand new
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  and, and think you're going to make a big difference.
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  So, um, as you mentioned, we've seen that time
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  and time again from different entrants into the space,
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  and some have stuck around
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  and some have changed in, in some of,
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  you know, left to some degree.
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  And so when you look at the kind of broader space here,
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  who do you think is most best positioned?
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  Maybe not company by company,
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  although, you know, I would love to hear your thoughts on
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  that if you have thoughts,
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  but really in terms of, you know, um,
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  who within the healthcare
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  or non-healthcare space can really make the difference
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  that's needed in order to, um,
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  deliver better care, if that makes sense?
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  - Yeah, I, I, I think I, I think the thing
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  that's gonna be really critical, uh, and,
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  and part of this actually is shaped
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  by some recent conversations I've had with, um,
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  with physician leaders
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  and other folks, um, kind of internationally thinking about,
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  um, how they are approaching, um, you know, healthcare and,
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  and, you know, and disease prevention from
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  a societal standpoint.
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  You know, at the end of the day, you know, um, you,
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  you know, I think payers, um, I think health systems, um,
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  you know, uh, you know, individual, um, clinicians per, uh,
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  uh, you know, um, you know,
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  we all have a different stake in things.
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  But I think one of the things that I think will best, um,
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  align and ensure commitment, right?
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  Lasting commitment is like, how, what is the,
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  what is the population, right?
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  What is the constituency of, of, of interest?
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  Because, you know, I, I, now that I've worked, uh, you know,
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  uh, trying to, uh, negotiate contracts with payers, right?
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  But now as part of Intermountain, you know, we,
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  we have our own payer working inside that, that, um, that
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  that structure to, to kind
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  of see things from their perspective.
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  You know, I realize that it, it, it's
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  so much more complex than what, um, that that
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  what you see on the daily show, right?
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  Um, but, but what I do think is that, is there a way
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  that we can, um, activate, um, policy makers
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  and officials who have a, a lack, you know,
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  have a commitment to their community now beyond, and,
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  and again, and involve the communities in terms of
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  how they want to approach these things.
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  Because I, I think at the end of the day, um, you know, as,
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  as, as, as bullish I, as I've been in the past in, in terms
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  of, uh, participating in, you know,
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  in these new payment models
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  and whatnot, you know, these are kind of things
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  that are dictated by the length of a contract, right?
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  Maybe five years or so.
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  We really need to start thinking about
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  how do we integrate a sequence of these types
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  of contractual arrangements, connect the dots
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  so we have a more longitudinal, holistic view of
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  how we wanna approach health.
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  Um, and I, I think the big thing is, you know, obviously
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  until we stop, you know, until we stop the bleeding
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  or the, for these things like high cost hospitalizations,
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  readmissions, you know, preventable events like for example,
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  in the kidney space, people, um, you know, showing up and,
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  and the first time they see a kidney specialist is when
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  they, they start dialysis in the,
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  in the intensive care unit.
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  Those are things that if we can, we need
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  to eliminate those things.
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  'cause they are the low, low lowest hanging fruit,
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  although they're not easy to address.
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  But I think we need to work part
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  and par parcel with, you know, across a broad, um,
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  array of stakeholders.
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  So again, whether those are the leaders
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  of our health systems, people in industry, people who, who,
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  uh, are in public policy,
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  but also our, our, our, our,
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  you know, the people in the communities.
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  I think, I think ultimately healthcare, you know, we,
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  we keep hearing as a consumer driven industry, uh, I've yet
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  to actually see that consumers exercise their full
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  power in terms of influencing how we invest in,
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  in keeping them, keeping them healthy.
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  - That's such a great point.
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  And definitely, you know, fascinating to see how everything,
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  you know, will play out over the next few years.
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  And speaking of these changing market dynamics
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  and certainly, um, you know, where healthcare is headed,
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  what do you think, um,
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  most effective healthcare leaders will need in order
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  to be successful over the two to three years, um,
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  in the future, especially as I mentioned, thinking
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  through these changes in what really, um,
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  will make the biggest difference?
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  - Yeah, I, that, that's,
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  that's actually such a foundational question and, and,
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  and that ties this all together.
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  You know, Laura, um, earlier in my career, I, I, I was, um,
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  the VP of, of quality, um, at, uh, an indu for a, a company,
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  an industry in the, in the kidney health industry.
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  And, um, I, I, I really, really, um, learned so much about,
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  uh, about, uh, you know, Deming's teachings, quality,
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  you know, focus on the process, not the people.
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  But now as I, you know, 20 years later as I,
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  as I look back at, at, at what I've experienced,
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  and now looking at the landscape,
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  I think process is obviously really important.
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  We need to double down, triple down on the people, um,
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  the pandemic, as you know,
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  and I won't recapitulate what we know is, you know, put,
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  you know, it was really so, oh gosh, so, um, so harmful
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  to our, our caregivers, physicians, nurses, other,
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  other folks that are, you know, taking care of people,
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  you know, in, in the pandemic and whatnot.
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  And so now we are in this, um, you know, kind of,
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  I guess we're still, I guess we're post pandemic now,
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  but you know, the, the, the economics
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  and finances ha are are back front and center, and they're,
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  and they're making health systems, including Intermountain,
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  you know, have to make some really tough, you know, choices.
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  I, I think keeping our, our people whole, um,
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  and ensuring, um, not, not just,
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  not just having an initiative for employee wellness,
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  but truly looking at the near
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  and long-term needs of the people
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  that have dedicated their lives to healthcare.
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  That's what an effective leader needs to do.
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  'cause without the people, it's not gonna happen.
• 15:36
  - Absolutely. I love that. Dr. Wong, thank you so much
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  for joining us on the podcast today.
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  This has been a fascinating discussion,
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  and I look forward to connecting with you again soon.
• 15:43
  - Yeah, thank you, Laura. Again, thank you so much, uh,
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  to Beckers for inviting me to, uh, share my thoughts.