Latest / Becker’s Healthcare - Clinical Leadership Podcast / Dr. Daniel Durand, Chief Clinical Officer at LifeBridge Health

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Dr. Daniel Durand, Chief Clinical Officer at LifeBridge Health · Becker’s Healthcare - Clinical Leadership Podcast

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  This is Laura Dedo with the Becker's Healthcare Podcast.
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  I'm thrilled today to be joined by Dr. Daniel Duran,
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  chief Clinical Officer at LifeBridge Health. Dr. Duran,
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  it's a pleasure to have you on the podcast today.
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  Thank you, Laura. It's always a pleasure to be here.
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  Now I know you've jumped on the podcast with us a few different times,
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  and we always appreciate you and your time and expertise. Um,
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  but for those of our listeners who have just joined us,
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  could you tell us a little bit more about yourself and your background?
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  Absolutely. So my name's Dan,
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  and I'm the Chief Clinical Officer for LifeBridge Health. LifeBridge is a five,
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  uh, hospital, 2.5 billion revenue provider in the state of Maryland.
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  Uh, we have a real cross continuum of care type model.
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  We have about as much revenue coming from outside the hospitals as within the
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  hospitals. Uh, and you know,
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  I think we've been very much at the forefront of things like value-based care
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  and various different types of technological innovations and consumer-oriented
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  innovations within healthcare these past few years. Uh, my role at LifeBridge,
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  I focus on, uh, value-based care,
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  and I also am over operations for our clinically integrated network,
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  which encompasses, uh,
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  the assets I told you about along with our partners network and, um,
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  other affiliated groups,
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  all of whom are part of this network delivering care to populations.
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  Some of those populations are value-based populations and others are,
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  uh, government programs that, that are, may have a value orientation to them,
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  but they aren't necessarily capitated type populations.
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  That makes a lot of sense, you know, and,
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  and really is interesting to see how that, um,
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  that's evolved with the value-based care and being on the forefront of it.
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  I can imagine, you know, just really a lot of, uh,
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  experimentation and figuring out what works. So that's great to hear.
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  Based on where we're at today in healthcare,
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  what are some of the big opportunities you have your eye on as well as the
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  headwinds that are popping up?
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  Well, I think the single biggest thing, uh, as a healthcare operator, uh,
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  and it's a little more on the parts of my job that involve the medical group,
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  um, and the hospital based physicians versus the, um,
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  versus the network. But I, but there,
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  there's a real provider shortage going on in healthcare today,
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  and it has a little bit to do with covid that we're coming out of.
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  And it has a little bit to do with, um,
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  the changing nature of the workforce and, and the shift of, uh,
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  patients and opportunities to care for them from the inpatient to the outpatient
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  world. But I think it has a lot to do with the,
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  in increase in demand related to the aging population. You know,
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  that's just been my personal anecdotal experiences is that there are a
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  fair number of retirements happening right now across the country.
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  Folks that were maybe hanging on for a little bit longer, you know,
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  during the pandemic, a lot of them are finally retiring. Uh,
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  and then there are also a great deal, um,
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  of patients that are in that 65 to 75 age group where they're starting
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  to acquire chronic conditions and starting to have, you know,
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  unfortunately real health issues in that sort of mid to early baby boomer
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  populations. So as we see that,
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  I see a lot of demand and I see hospitals, um,
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  all hospitals that,
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  that I'm aware of having real challenge populating and staffing key areas.
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  This can be on the nursing side, it could be on the respiratory therapist side,
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  and it's certainly on the behavioral health side, it's across the board,
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  you know, but for physician leaders,
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  what it means is one of your biggest priorities and, and,
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  and headwinds that you're dealing with is, um, an ongoing provider shortage.
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  And what I tell people that are getting into healthcare management or people
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  that, you know,
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  our peers asking my opinion as to whether when this will get better,
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  I I just say don't plan on it. Getting better plan on.
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  So this is a storm and I think it will be here for the rest of my professional
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  career. You know, I plan on working another 20 or 30 years.
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  So that's my personal opinion is I just looking at the demographics of this,
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  I don't see it necessarily getting better.
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  So it means you just have to learn how to live with it.
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  You have to learn how to be in sort of a labor first mentality in that
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  your first consideration before you think about their workflow or what they're
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  gonna be doing. You have to make sure you have a competent person,
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  a compassionate person, a qualified person in that chair to deliver care.
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  So that is number one. Um,
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  the second thing is kind of related to that,
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  putting our hat on and thinking as the employer of the patient.
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  So the first hat is kind of employees first in a way,
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  but the second hat is who are our customers and who funds us really?
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  And obviously the government is one entity,
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  but the other entity is the payers and,
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  and the money from them is coming from employers. And, you know,
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  the need that I'm seeing is you're hearing more and more, um,
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  as inflation has increased, you're hearing a few things like, first of all,
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  health systems are very reasonably saying,
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  we need more money to take care of patients cuz it's costing us more money.
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  You can't have year over year wage growth in the 10% range and in some
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  specialties higher, you know,
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  once that goes on for a few years and it's compounded, your cost structure is,
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  has grown by quite a bit. And you know,
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  as I alluded to in the first point point,
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  like that's not really within any one systems control.
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  And so it's an impact in the whole industry.
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  So it's reasonable to expect that payers would, would make concessions on rates.
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  Um, however the payers are,
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  they are beholden to employers and the employers are trying to maintain
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  competitive salaries.
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  And so these employers are out there really trying to pay more out to the
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  employee,
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  and they're tending to really wanna leave benefits flat from a cost perspective
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  if at all possible. So there's,
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  I've heard more conversation and buzz amongst, you know, my contracts,
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  my contacts in the industry and, and elsewhere and,
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  and even in other industries about the need, uh,
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  to constrain healthcare costs within employees. You know, it was very, very, um,
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  common conversation about 10 years ago.
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  And then as the economy picked up and the focus was put elsewhere,
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  you heard less about this within healthcare and then during covid you heard
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  nothing about it. But really this is now an issue. Um,
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  and so that kind of leads naturally to will we see a resurgence in
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  interest in things like value-based care and, and value-based contracting.
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  And I think we will, and I think we are seeing that. Um,
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  and the last point is we are in the midst of an age of just incredible medical
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  innovation, uh, you know,
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  to a level that I have not experienced in my career, which is, uh, you know,
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  surprisingly in its fourth decade,
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  I happened to have published my first scientific paper in the nineties when I
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  was pretty young. So I've been in health and science for about, you know,
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  over parts of four different decades. And I have never seen,
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  um, so many things coming outta the woodwork, uh, that are promising.
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  And it, it's sort of, um,
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  very humbling to think how we'll pay for all this and how we'll implement it all
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  on the delivery side.
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  But you have things like cart therapy that are revolutionizing cancer therapy.
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  You have mRNA vaccines and other uses for mRNA,
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  including personalized cancer vaccines. You have incredible, um,
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  progress in biomedical engineering and things like spinal stimulator devices,
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  you know, patients that are learning to walk again after being paralyzed with,
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  with, um,
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  implants that can sense their thoughts and then really those things to their
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  muscles in a way that their broken spinal cord can't.
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  So these things were like science fiction when I was training, and I'm not,
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  you know, not that old. So it, it, you know,
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  somehow we have to make good on all this.
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  We can't let the first two things be the choke point that prevents us
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  from democratizing and giving access to these incredible innovations.
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  Absolutely. That's really exciting to hear. And,
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  and just looking at where we're at today, as you mentioned in, in terms of, uh,
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  healthcare innovation and in advancement. And I, I love that idea too,
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  of just making sure that, you know, you keep your eye on the,
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  the things that will bring it forward, um, and not, uh, you know,
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  letting that die on the implementation side. Um, and, and two,
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  when you think about and talk about value-based care, it's awesome to,
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  to hear and see that it's accelerated to some degree and really, um,
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  becoming more innovative there. From your perspective,
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  how do you really see growth and adding value to your organization?
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  What does that look like in, in, in a practical sense? Um,
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  how do you think about that and how it will evolve in the future?
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  Yeah, and this year, I think, um, where I'm focusing just,
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  and a lot of it's just based on, on my role and where I focus as I referenced,
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  um,
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  really and centered on issues of clinically integrated network and
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  value-based care that kind of come hand in hand.
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  You're thinking about how do populations access networks of care,
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  how is their care coordinated? How do they experience it? Um,
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  so they have the sense of value, right?
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  They have the sense that there is a good experience,
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  that they're getting the outcomes they want and whoever's paying for it,
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  which is typically some combination of them and their employer,
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  that both entities feel that they're getting, um, better value than,
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  than they can at the competition, right? So this year,
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  I think for us it's about the, um,
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  reinvesting and the capabilities of value-based care in a lot of ways because
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  during c o the focus was very much on doing a,
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  a huge number of things for, um,
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  for the folks that we serve and for society, you know, uh,
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  that we weren't asked to do and that nobody had anticipated, right?
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  A lot was asked of health systems and, and a lot was given too. I mean,
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  there was a lot of support,
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  but it certainly changed the strategic and tactical focus for three to
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  four years from when it hit until around now.
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  And now I think we're kind of going back to an area where the, uh,
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  the macro forces are pointing us more to,
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  to focus on the total cost of care and the various different measures of
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  quality, one of which is patient experience.
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  So some people hold that separately, you know, I kind of, uh,
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  think of it as in there with quality. Um, and then another thing that,
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  that I think has clearly popped out to the side of that in the sense that it's
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  exclusive from that is equity. Um, that is,
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  if I go back to the pre covid iteration of value-based care,
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  there was not a ton of focus on equity at the, um,
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  reimbursement level. I mean, they, they would sort of ask you what,
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  how you were doing quality-wise, and they would measure it, but they weren't,
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  um,
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  requiring as much and as thoughtfully as they are now in, in their,
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  they weren't saying, listen, what are the outliers look like?
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  Are all the different populations getting the same care?
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  Are there folks that we know need extra things given to them
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  to ensure the access in terms of coordination and transportation, et cetera?
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  Can you prove to us that they're getting that?
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  So we are seeing that more in value-based programs in this sort of new age of
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  value-based care. Um, so the,
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  the reinvestment and refocus on this is, um,
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  I think it's a body of work. It's not any one, uh,
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  line item investment, but strategically,
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  I think of it as one investment that we're, that we're making, uh,
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  this coming year.
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  Got it. Absolutely. I love that. And it is just,
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  it's definitely important to have those investments that will set you you up for
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  success in the future. And to your point, when looking at the iteration of,
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  um,
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  value-based care now being able to take into consideration health equity more
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  than in the past and, and, uh,
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  what that means to care for the whole patient and patient populations, um,
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  you know, it is amazing to hear from your perspective,
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  obviously a lot of experience on the clinical side, but, you know,
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  how are the technology supporting that data, supporting that, and, and really,
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  you know,
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  what do you need from the organizational level to make sure that people are, um,
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  using the technology in and, uh, using the data in a beneficial way?
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  Well, we've, we've made a lot of investments as a health system, as have many,
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  uh, medium and large size health systems on patient navigation functions.
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  Mm-hmm. things like call centers and command centers. I mean,
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  all of this is sort of like, um,
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  the brain of the health system that helps navigate the patient because a health
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  system, if you just think about the two words, right? I mean,
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  it's focused on health, but it's supposed to systematize something.
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  And I think of it as in its smallest unit. It's, it's,
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  we need to make sure that the patient is able to get where
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  they need to go to get good care. Because before they were health systems,
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  they were doctors and they were, they were, they had their,
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  their shop with their little sign and, you know, they were all doing business.
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  So you had that before you had health systems.
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  So what we add to the equation is a way to supercharge that.
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  And you see it in things like a command center or a call center,
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  an navigation center, um, but you also see it in cell service tools.
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  So increasingly it's in the automated digital apps that health systems have.
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  And we've been working on ours for the last couple years to let the patient, um,
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  have more of a self-directed,
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  self-guided relationship with their data and with what's out there to help them.
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  So they might put their symptoms in there,
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  or they might use it as a way to look at their own records and their data. Um,
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  and over time,
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  I think those things will come together that certain patterns and data will be
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  used to make push notifications to patients. And some places are,
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  are already doing that, and in some corners of our organization,
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  we're doing that. But I think that over time you'll see that come together,
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  those investments of a consumer digital first approach where,
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  uh, they, they have sort of authorship, um, and ownership of their data,
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  but they're also having a bidirectional relationship with it. And, um,
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  when they need to, they're speaking with a person,
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  but they don't always need to,
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  and they might just want to interact with their data or book their appointment
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  online or look at their own chest x-ray, who knows? I mean,
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  there are a lot of things they may wanna do. So setting up the, um,
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  the infrastructure for that,
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  and EHRs I think are getting better and better at this. Uh, and,
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  and there's a whole cottage industry that help around helping health systems
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  create their apps and their portals. But I also see that the big, um,
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  you know, players in this, like Epic and Cerner have,
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  have also made tremendous strides. Um, so I think there's the, the,
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  those two functions,
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  the health system sort of command center navigation function,
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  that's usually a call center with a lot of data and resources behind it,
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  coupled to the digital, the, the automated, the app. Um,
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  these are two big things that, that many health systems are doing. It's,
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  they're, they're too big industry trends,
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  and they're very much related to value-based care in the following way. Um,
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  number one, they, they engage the patient digitally, so you have a broader,
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  more longitudinal relationship with them. And for most value-based programs,
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  a big part of what you're trying to do is prove that the patients are getting
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  certain type of preventative care,
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  and there's the type of preventative care that everybody needs.
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  And then there are also population specific types.
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  So diabetics need to get their retina screened. They need to get, uh,
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  checked for foot ulcers, they need to get an A1C done.
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  So most of the different payer programs have these things in common.
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  And if you have a touch point with a patient and some means of bidirectional
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  communication for the 99.9% of the time that they're not in the hospital,
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  that with them or with their caregiver, that's incredibly powerful. I mean,
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  that's, that's always what we've been trying to accomplish with things like care
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  managers.
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  So these additional digital tools and capabilities make population health just a
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  lot more possible. Um, and then beyond that,
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  and this is the level that I think that most aren't quite there yet, in,
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  in aggregating that data and having the ability to sort of ask, uh, um,
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  patients for additional points of data,
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  there's the chance to sort of predict things that we can't predict today to
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  predict who is sick and who isn't sick, you know, with,
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  with diagnoses they may not be aware of.
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  So who should get an extra type of screening, for example, um,
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  to predict who's about to get really ill to predict,
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  um, who needs an extra appointment in person to check on them.
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  And then also to predict who's going to be minimal to different types of
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  interventions. Um,
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  so the predictive aspects and predictive analytics has also been something that,
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  I'd say it's been hot for at least a decade,
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  but with all the machine learning algorithms and with this,
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  with the fact that it's been 15 years since high tech and data is now so
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  ubiquitous, um, you're really starting to see where this is, um,
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  having an impact,
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  that there's a huge open space here to where even doctors that don't work
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  for a health system or providers that are out there on their own, um, there,
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  there's a day coming where they can do very sophisticated things with data,
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  I believe at a very low cost on behalf of patients.
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  Absolutely. I, I love that. I think that makes a lot of sense,
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  sense and so helpful to think through and understand on the data level,
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  you know,
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  what that can really do if you utilize it correctly and have the appropriate
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  systems in place. Now, before we wrap up our conversation, I wanted to ask,
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  where do you see some of the best opportunities for growth and development in
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  the future, both for yourself as well,
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  well as the teams that you work with as healthcare evolves?
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  Well, I, I mean, I think it's really exploring, um, those things.
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  So I think people grow when they're focusing on the things that they're most
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  passionate about. And, um, value-based care, for me,
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  the reason I have a, you know,
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  great passion about it is I've seen people with a great deal of resources
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  go through the health system, um, and, and not necessarily get much out of it.
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  And I, I said this, this is the US health system, not,
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  not any health system in particular. Um,
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  so it's not just a question of resources.
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  The idea about value is sort of the idea of can we achieve these outcomes with
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  higher efficiency and can we achieve them more commonly?
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  We know that the United States, right, PRODU has produced,
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  um, a ton of healthcare innovations,
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  maybe the majority of the innovations over the last hundred years or so,
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  but we know that,
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  that there are other countries that just totally outperform us when it,
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  when it comes to getting the outcomes from those same exact interventions.
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  So we just need to learn how to be more consistent. So I think that, um,
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  a lot of the growth for organizations,
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  and what I'm planning on focusing on is how can we take those things that we
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  know we've done, like at our best for our, you know, on our best day,
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  what is our department done on our best day? What, what has our team done?
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  How can we bring that a game to every single encounter to,
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  to the patients that didn't make it in front of us that day that we happen to
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  all, you know, come together and do it well. So to me, that's the growth is,
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  is how do we get more standardized? How do we leverage data to,
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  to make healthcare like as reliable as the aviation industry? I mean, that,
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  that's when I talk a lot with my teams about how do we get that level of
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  reliability, um,
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  because we certainly should have it in healthcare and we have it when we have
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  things like an or, right? Or like a specific radiology exam.
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  So the individual pieces, we know, um,
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  we can do incredibly well, but we also know that longitudinally,
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  you know, we, we, we still only get mammograms as a nation on like 30 to 40, uh,
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  well, uh, on like 60% of the people that, that need them. I mean, that's,
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  that's, imagine it's a plan only landed 60% of the time. Like we,
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  that be a problem, right? So that, that's what I,
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  I think it really is a lot about just how do we get more reliable?
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  How do we bring all these innovations from, um, from data and,
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  and big tech to just up our game and be as good as we can
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  be on our best day, but for every case.
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  That's amazing. Dan, thank you so much for joining us on the podcast.
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  An inspiring note to leave on. Um,
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  and I'm looking forward to seeing you in person as well of the Health IT Digital
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  Health and Revenue Cycle event, um, in October here in Chicago.
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  It'll be such a fun time. I know a lot of these themes will be talking,
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  talking about there and, and really expanding upon digital technologies,
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  artificial intelligence, and more. So I'm looking forward to it.
• 21:00
  Thank you so much, Laura. Always, always a pleasure.