Latest / CareTalk: Healthcare. Unfiltered. / Putting Patients Over Profits with Stacey Richter (Host, Relentless Health Value)

Transcript

Putting Patients Over Profits with Stacey Richter (Host, Relentless Health Value) · CareTalk: Healthcare. Unfiltered.

• 0:00
  If there's any chance of achieving the quadruple aim of great population health, patient and provider experience and cost containment, we simply have to be relentless in pursuing it.
• 0:11
  So who could be better than Relentless Health Value Podcaster, Stacey Richter to share what it takes.
• 0:18
  Her listeners, the Relentless Tribe, have one thing in common, a desire to put patience over profits and do well by doing good.
• 0:26
  We'll hear her manifesto and discussion about the financialization of the U.
• 0:31
  S.
• 0:31
  healthcare system.
• 0:40
  Welcome to Care Talk, America's home for incisive debate about healthcare business and policy.
• 0:45
  I'm David Williams, President of Health Business Group.
• 0:48
  And I'm John Driscoll, the President of Walgreens Health.
• 0:50
  Welcome, Stacey.
• 0:52
  Thank you so much for inviting me to be on your show.
• 0:55
  I am thrilled to be here.
• 0:58
  Well, John, before we get started, I have a favor to ask.
• 1:01
  If you or the listeners are enjoying the show, could you please leave a rating or review of the CareTalk podcast on your favorite streaming service?
• 1:09
  That helps us stand out from the crowd and lets others find us.
• 1:13
  Including Stacey.
• 1:14
  Yes, thank you, Lister.
• 1:15
  Stacey, tell us a little, a manifesto.
• 1:18
  How did you come up with a manifesto for healthcare?
• 1:22
  Well, I think that David alluded to how this whole thing got started, actually, which is the whole doing well by doing good.
• 1:33
  Which everyone talks about and kind of throws up as their guiding light or their north star.
• 1:40
  I am a very, um, gotta have a framework, you gotta figure out, like, how actually do you operationalize that?
• 1:48
  So this...
• 1:50
  It is that thought process or that, that was the whole starting point here.
• 1:55
  If we say that we're doing well by doing good, what does that mean exactly?
• 2:00
  And how do you know if you're achieving it?
• 2:05
  So everybody knows what Doing well means what is doing good?
• 2:11
  That's the question.
• 2:13
  And it's also a matter of balance, right?
• 2:16
  Because you can't just do good.
• 2:22
  You'll go out of business in this country.
• 2:26
  But if you only do well, then obviously you're contributing to probably some not so great things.
• 2:34
  What it all boils down to is a matter of nuance.
• 2:38
  Really, how do you know, you know, what's your sweet spot there where you're not overbalancing in any given direction because too much of either is probably not going to get you where you want to be.
• 2:53
  You may have to be really super clear because Dave has a really hard time with nuance, don't you?
• 2:57
  Dave?
• 2:58
  Yeah.
• 2:59
  Um, yeah.
• 2:59
  Yeah.
• 3:00
  Yeah.
• 3:00
  Yeah.
• 3:00
  The entire healthcare industry is probably part of the issue here.
• 3:04
  I like that.
• 3:05
  I got the doing well part, John.
• 3:06
  I got that part.
• 3:07
  Is that what you meant by nuance?
• 3:08
  You've nailed that.
• 3:09
  Show me the money.
• 3:14
  But David, seriously, how would you characterize doing good and challenge Stacy?
• 3:20
  I don't know.
• 3:20
  You know, so here's the challenge.
• 3:22
  You know, when I think of a manifesto, Right.
• 3:24
  First of all, I'm, I'm worried.
• 3:25
  Are we still allowed to talk about that in this country?
• 3:27
  You know, that could be that we could be, we could be censored, but it sounds very long.
• 3:31
  Only, only, only by Google.
• 3:34
  Okay.
• 3:35
  Well, when you talk about nuance.
• 3:37
  Which will probably get us censored.
• 3:38
  Fair, fair enough, John.
• 3:40
  But, but Stacey, if you think about manifesto, when you talk about nuance, is it, is your manifesto something that can be stated in, in a couple of sentences or is it, or is it like thousand pages long?
• 3:51
  No.
• 3:51
  And this is the whole point I think of having a manifesto, which I would, you could also call it a framework, a decision making framework.
• 3:57
  You know, I think that there's, and I can state mine outright, there's three components to it.
• 4:03
  And then we can kind of talk about why I think it's so important that everybody actually has one.
• 4:08
  Um, the first component is, so.
• 4:11
  You know, setting the stage here, someone asked me to do something.
• 4:15
  I will ask myself three questions or contemplate the ask in, in, in three, among three parameters.
• 4:22
  Number one, is this a net positive for the patient?
• 4:28
  Because there's always going to be an upside and a downside.
• 4:33
  You know, you, you do something, there's always the potential that you're going to raise one of the quadruple aim quadrants and another one's going to diminish.
• 4:42
  Um, so if we think about this as a net, In net terms, what's the net positive?
• 4:48
  The 2nd contemplative point that I like to think about is what's the timeline?
• 4:57
  Um, and I hold myself to a short to medium term timeline, not necessarily a long term timeline, but, you know, everybody's got to have a different one and, and think about things in a different way.
• 5:08
  And then the third point of contemplation is this will take a village.
• 5:14
  I remind myself of that, and then contemplate kind of like how.
• 5:20
  And who needs to be in the village here with me in order for this again, to sort of all spiral up to a net positive.
• 5:27
  So those are the 3 components there.
• 5:29
  And I am happy to dig into any or all of them.
• 5:33
  I think Stacey, the interesting point is the 1 you started with.
• 5:39
  Which is that, that the quadruple aims, if you could just walk through what that is and what the trade offs can be, because people kind of spout about it.
• 5:49
  David, I'm not calling you out.
• 5:51
  As if it's simple or that they're all consistent.
• 5:56
  And I think you, your point about nuances, let's start with the heart.
• 5:59
  There are real trade offs.
• 6:02
  Yeah, there sure are.
• 6:03
  So the quadruple aim, and I've, I'm hearing the quintuple aim now, but the quadruple aim, thank God we haven't gotten sextuple.
• 6:10
  Yeah, it's a family show.
• 6:15
  It all adds up to good, good stuff, right?
• 6:18
  Um, but the quadruple aim is largely, um, it, Let's talk about, um, making sure that everything is affordable, that we have better patient outcomes, that we have better patient experience, um, that, and physician satisfaction.
• 6:34
  So we have all four of those, of those things.
• 6:39
  And Stacey, you know, you mentioned it was, it was the, the triple aim to begin with, and the sort of the provider satisfaction got added, which is interesting because on the one hand, you know, who cares?
• 6:50
  They're just sort of the supplier.
• 6:52
  You know, now that we don't usually care.
• 6:54
  It's because your brother's a doctor.
• 6:55
  Yeah, I got multiple brothers, John.
• 6:57
  So, you know, if one's happy and the other isn't, that's how it goes.
• 7:00
  But, you know, it got added on to, and then there's a sense there's sort of a pressure.
• 7:03
  And you mentioned it, quintuple aim, you know, so you want to have everything.
• 7:06
  Well, there's trade offs, right?
• 7:08
  And one of the trade offs is the healthcare is so expensive.
• 7:10
  that people can't afford it.
• 7:12
  So maybe the doctor's happy because, well, they didn't have to see that many patients.
• 7:16
  But then from an access standpoint, the patient can't see the physician because the physician needs to be happy.
• 7:21
  They're not going to get better or the cost is going to be high because it's going to be a concierge practice to achieve that.
• 7:27
  I mean, John, I think those are the sort of things you're talking about.
• 7:30
  Yeah.
• 7:30
  And I guess, Stacey, how do you resolve that in the context of a manifesto that says, you know, sort of here I stand, I can, I can, you know, uh, I, I kind of think of Martin Luther nailing the, the rules to the door or David, you know, hanging out with his communist friends and going through the communist manifesto.
• 7:51
  And the manifesto is a bold way of describing values and actions.
• 7:57
  That are in the, in the, in the future.
• 7:58
  How do you think about trade offs in the context of your manifesto?
• 8:03
  It is bold and it does take courage.
• 8:06
  It takes courage to really take a stand.
• 8:09
  And I think that is why I chose to use the term manifesto as opposed to something that may be a little less, um, um, bold.
• 8:21
  Um, the, the idea here though is, you know, I think a lot about.
• 8:29
  Organizational the tragedy really of organizational decision making and what has happened in the healthcare industry as it becomes more complicated.
• 8:39
  We have so many people who are involved in every single decision.
• 8:43
  Everybody can be, but a cog in the wheel and what winds up happening is that then people's role and responsibility and their ownership is limited to that cog and therefore.
• 8:56
  Nobody sort of starts taking responsibility for the overall impact of all of these micro decisions and what ultimately winds up happening relative to the quadruple aim or any other benchmark that we want to hold ourselves accountable to.
• 9:11
  So, I, I think, relative to having a manifesto to a certain extent, 1.
• 9:19
  Because what it does is it forms whatever anyone chooses to put in their own.
• 9:24
  It, it creates a, a, an imperative, really, to think through what it is that is going on.
• 9:34
  And does the ultimate impact of that align with your North Star, whatever that might be, to your moral compass?
• 9:43
  Is this aligned?
• 9:45
  So you're, you're, you're, you're using.
• 9:47
  Well, David, I just wanted to give a very practical example.
• 9:50
  It happened in my family where we had a relative die at a hospital, and we had the means to kind of actually ask a certain series of questions to the care team, and there were multiple specialists, and it was quite clear that, that to the different specialists that the patient, my aunt, or you know, Right.
• 10:11
  Relative was in extremis.
• 10:13
  And was it, was it the, was it, was on the bubble of, of, of whether she was going to survive or not.
• 10:19
  And no one thought to communicate that to the family.
• 10:22
  They just were sort of doing, and they were doing good work and doing the best they could.
• 10:27
  But that lack of communication created much more trauma and it was people doing their job.
• 10:32
  I think when you're, I don't want to, I thought I'd try to, and I apologize for interrupting you, David, just draw it to very, this, and I think this is a day to day thing in healthcare.
• 10:42
  Someone Blowing through the ER with different diagnoses that are poorly communicated to patients that then have corollary or ancillary services that the family may not even know about, let alone those that in the tragic situation of death.
• 10:57
  But there is a, there's just a natural tendency of a non team based system that doesn't have clear aims, not even communicating at times things that, that are really pretty critically important to families.
• 11:11
  and patients, uh, and, and caregivers.
• 11:14
  Sorry, Dave.
• 11:17
  Well, I was going to say, you know, Stacey kept the manifesto nice and short and sweet.
• 11:20
  And, and John, thanks to your verbosity, I think it's about the length of the Unabomber's manifesto, although it's great.
• 11:27
  Great.
• 11:27
  Great.
• 11:28
  Great.
• 11:28
  Dave.
• 11:29
  It's a little easier.
• 11:30
  It's a little easier to follow, John.
• 11:32
  If we didn't, if we didn't get censored off in the first comment, my, my, my insult to Google, that'll, that'll, that'll, that'll trigger a bunch of flags.
• 11:39
  And the only question, John, is whether your mother's going to turn you in.
• 11:42
  But, uh, let's move on to the next topic, uh, which is, which is another phrase, uh, that maybe a, a term that you coined, I don't know, Stacey, I hadn't heard it before.
• 11:51
  Financialization.
• 11:54
  And I think even though I hadn't heard it, I kind of understand it, but you know, what does that mean and what are the implications?
• 12:00
  It's I mean, it's a big word, like all those syllables.
• 12:03
  So maybe you could break it down for Dave.
• 12:04
  Don't get upset, John.
• 12:07
  Don't take it out on me.
• 12:08
  Yeah, I talk about the financialization of healthcare, of the healthcare industry a lot because it's really undeniable at this juncture.
• 12:16
  Which again, is just another reason why it's so important that we all, you know, anyone who has a moral compass really.
• 12:25
  Contemplates how the things that we're doing impact the humans, um, that are kind of at the end of at the end of this.
• 12:35
  Um, well, I mean, I can just whip through some stats here relative to the great.
• 12:39
  Sure.
• 12:39
  I say the financialization did help Dave contextualize things.
• 12:43
  So first of all, healthcare affordability is regularly, you know, like, if you want me to cite, cite 5 to 10 polls and studies, I can whip them off the top of my head, but healthcare affordability is regularly ranked amongst the most important issues facing America.
• 13:00
  I mean, Gallup just did a poll and healthcare affordability was the.
• 13:04
  Was the number one list number one on the list, which was higher than inflation and fear.
• 13:11
  And it's just to be clear, healthcare unaffordability for patients.
• 13:15
  Yeah.
• 13:16
  Thank you.
• 13:17
  Um, uh, we, we also had a KFF poll the other day that half of adults in the U S say that a family member or themselves abandoned or delayed medical treatment because of its cost.
• 13:31
  So, you know, like, Hey, I have this thing on my arm.
• 13:34
  Is it melanoma?
• 13:35
  I don't know.
• 13:36
  But I do know for a fact if I go to the doctor and get it checked out, I'm gonna be 600 bucks in the hole.
• 13:41
  So I won't, right.
• 13:43
  I mean, there's, there's, it's easy to cite numbers, but, but that's what we're dealing with.
• 13:47
  Oh, I have chest pains.
• 13:49
  Do I go to the er?
• 13:50
  I think.
• 13:52
  Um, scared of that ambulance ride and, and, you know, the bounce billing that it's gonna net.
• 13:58
  Um, you have, I've heard anywhere from a quarter to a third of Americans who are dealing with medical debt.
• 14:05
  I've heard one in eight Americans has debt that's over 10, 000.
• 14:11
  Um, Paul, of course, of bankruptcy.
• 14:15
  So how do you how do you that's affordability?
• 14:18
  But I think when you talk about financialization, Stacy, you're really talking about, you know, how how many ways in which health care is treated like a standard financial asset as opposed to a natural resource that's driven.
• 14:34
  It's sort of based in values.
• 14:36
  And maybe gave other examples of that that are, that are triggering.
• 14:40
  And I love how you set that up because one of the reasons why you could kind of tell if something is financialized is when the values that the system promulgates are in misalignment with the values of most Americans.
• 14:53
  And we have that right now.
• 14:54
  I mean, relative to what is driving the financialization or examples of the financialization, I mean, Paul Keckley in his newsletter just yesterday was talking about how the big consolidated health systems in this country, um, are more closely associated with big business than not for profit health.
• 15:15
  You have the, you know, big consolidated vertically integrated payers in this country who are some of the most profitable companies in the Fortune 500, right?
• 15:28
  Like there is big, big money.
• 15:30
  You have, um, you know, if you read the quarterly earnings reports, if you actually read.
• 15:38
  What's on venture capitalist websites and private equity websites.
• 15:42
  There is no question that the goal of the endeavor is to make money.
• 15:48
  And, you know, I guess do you hate the players or you hate the game, right?
• 15:52
  Like the stock market doesn't trade on patient outcomes.
• 15:55
  So as long as we have an industry, um, That is gunning in the same direction that it currently is without, without people inside of the industry having manifestos or, or really thinking through what the consequences are of actions.
• 16:17
  And I think, I think you're, and I think you're, you're the, as I understand your point, it's not that money isn't important.
• 16:24
  It's just that money can't be the only thing.
• 16:28
  We have a quadruple aim, which is highly tipped in the, or the doing well by doing good to your point at the very beginning, David, the whole doing well by doing good.
• 16:40
  We're doing well.
• 16:43
  So Thank Stacey, one thing that I see a lot of on your show is you talk about medical practice and clinical integration.
• 16:51
  It's a big thing.
• 16:52
  You get various perspectives on it.
• 16:54
  And one of the things that struck me was, you know, is kind of a comparison with some of these newer team based approaches.
• 17:00
  Compared with maybe the, the idealized old sort of, you know, Marcus Welby idea of, I'm just going to call my doctor, go to my doctor and so on.
• 17:06
  No one knows who Marcus Welby is.
• 17:10
  It looks like you're in the middle of the matrix.
• 17:14
  Like, you want to explain what you mean by that?
• 17:16
  So in the olden days, When I was young, you know, you'd have a doctor, and I'd call my doctor, you know, Dr.
• 17:23
  Smith.
• 17:24
  Dr.
• 17:24
  Smith's gonna answer the phone, or he's gonna call me back later, I can come in tomorrow, maybe later today if I'm not feeling well, and back in John's day, it was, they might even come and do a, you know, horse and buggy.
• 17:35
  They would, they would actually, they would, John used to raise an extra chicken in case he had to pay the doctor.
• 17:41
  In horse and buggy country in Pennsylvania, Dutch, Lancaster, my language, outside of there.
• 17:46
  Yeah.
• 17:48
  So John, I don't know why you asked me to explain Marcus.
• 17:51
  Well, but I'll, I'm sure you could find it on YouTube.
• 17:54
  If Dave, if Dave gets lost here, we can, we'll, we'll go find it.
• 17:58
  We'll send someone to go find him.
• 17:59
  So Stacey, the, pooing.
• 18:06
  Comparing it with the sort of simple older thing.
• 18:08
  And it's not so straightforward.
• 18:10
  Um, you know, where do you come out on what, what you're seeing in terms of both the challenges, a lot of what you've been talking about and, and success stories.
• 18:17
  I mean, what's, what's working with all those that are being relentless and, you know, in, in pursuing the right path.
• 18:23
  The one thing that I would really stress is the need for dyad leadership, which is to make sure that there's clinical on in leadership teams alongside of financial.
• 18:34
  So, I think anytime you're talking about anything, team based care, or anything, it's really important that there are physicians the leadership team in order to create that balance.
• 18:49
  When it goes horribly wrong, what team based care becomes is NMP, this NMP syndrome, not my patient syndrome, which is something that Greg Masters has been talking about and kind of circles back on what we were talking about before and that you had mentioned, John, this idea of like, it's kind of nobody's patient.
• 19:07
  Um, that's not team based care.
• 19:10
  That's a whole bunch of people transacting, um, and no one actually feeling responsibility for the patient.
• 19:17
  So when we're talking about team based care, I just want to make something really clear.
• 19:20
  Like, there's the euphemism team based care, which is actually a cost cutting exercise, um, that is not actually, honestly, team based care.
• 19:29
  You know, real team based care is a clinician, a doctor, um, who is sort of in This is kind of like a pit crew.
• 19:36
  I've heard it called where the patient is surrounded by the services that that patient needs.
• 19:43
  Um, you know, they have somebody who's coordinating community resources.
• 19:49
  They have someone who is able to educate and take the time to educate.
• 19:53
  They have all of the, um, benefits and, and the diagnostic capabilities and the insights that a physician can provide, right?
• 20:02
  It's everybody working together around.
• 20:04
  to support the patient and what matters to the patient.
• 20:08
  So that's real team based care.
• 20:11
  You could compare and contrast that to a Marcus Welby country doctor.
• 20:16
  And I think a lot of people let's just put it this way.
• 20:19
  If we had a choice between not team based care.
• 20:24
  And Marcus Welby, I think you'd be, everybody would agree that they would go with Marcus Welby, but it is a bit of a false construct.
• 20:32
  I don't, I don't buy that Stacey.
• 20:35
  And if you look at the best performing hospitals regularly in America, Mayo.
• 20:39
  The Mayo Clinic in Rochester, Minnesota, and the Cleveland Clinic in Cleveland, Ohio, not necessarily centers of, you know, of, of, of great, great academic, middle of great academic centers like Yale or us.
• 20:53
  You, you know, you know, uh, U S F or, or Harvard or whatever, and they, they are regularly.
• 21:01
  ranked as the best, um, in both in the specific things that are great at cancer and other things for Mayo and heart stuff for Cleveland, but they really emerged, um, as refuges that from doctors after the first world war who practice because they were at the front in, in teams and that culture of a clinical leadership, both of them are always led by a physician and work as teams has delivered reliably.
• 21:29
  better outcomes across multiple disease states.
• 21:32
  And yet it is exceedingly rare for other hospitals because they've grown up with this heroic doctor model and organized differently by department disease type.
• 21:44
  And I think a lot of our system suffers for not being more team based.
• 21:48
  And so I, I don't know, I, I, I'd, uh, I'm a Boston Celtics fan.
• 21:52
  I'll pick, I'll pick the team over the player.
• 21:55
  Dave's more of a Lakers fan.
• 21:56
  John, it's hard to, it's hard to know what you're, it's hard to know what you're disagreeing with, John.
• 22:00
  And maybe if you will, we'll go back to the Civil War and the Revolutionary War and, and, uh, you know, the War of 1812.
• 22:06
  I can't, I can't, I can't deal with your family references that go too far back.
• 22:10
  I, I, my, my family immigrated here in the 20th century.
• 22:13
  But what's fascinating to me is that both Cleveland and Mayo We're accused by the, uh, uh, AMA of being like communist cells because they were organized so differently.
• 22:25
  They got a lot of, they were attacked by institutional medicine, um, and I think emerged as independence probably because they were off the coasts and survived.
• 22:34
  And I think it's going to be really interesting.
• 22:37
  Yeah, so I just want to make something really clear.
• 22:39
  When I, when I was doing that dichotomy before I was comparing actually not team based care to an individual who was taking ownership for a patient and feeling responsible for that patient and making and taking it.
• 22:53
  taking personal accountability for, for that patient's outcomes.
• 22:56
  It's, and the reason I said it was a false dichotomy is because there's actually a third option, which is actual for reals team based care in which the physician is supported.
• 23:06
  And there is a whole team that's actually working together in a real.
• 23:12
  Way, um, to surround the patient, like, you know, the NUCCA system up in Alaska, for example, some of the advanced primary care models, right?
• 23:20
  Like there's a lot of examples.
• 23:21
  Yeah.
• 23:21
  Real advanced primary care, not just a way to reduce the primary care doctors.
• 23:26
  Yeah.
• 23:26
  Like there's just so many euphemistic terms that are flying around where people just like, find something that sounds good and then they check it out there.
• 23:33
  And it's actually the intent is quite different.
• 23:39
  Can we talk about the kidney?
• 23:42
  You know, so I noticed among all the things that you're involved, actually, John, sorry, there's two kidneys in most people.
• 23:48
  So I was wondering what was your question?
• 23:51
  Yeah.
• 23:51
  So, um, chronic kidney disease is something that you seem to have taken a real interest in.
• 23:57
  And what is the kind of, what's the situation with chronic kidney disease and how have you kind of applied your manifesto and participating in that?
• 24:05
  area.
• 24:06
  So I, um, am personally very interested in helping improve the lot of patients with chronic kidney disease in this country for a couple of different reasons.
• 24:23
  Number one, two out of five patients with end stage renal disease do not know they have kidney disease.
• 24:30
  50 to 80%, depending on who you talk to, 50, 80% of patients who wind up getting put on dialysis crash into dialysis in the emergency room, having had no prior treatment or, or no treatment, um, from a nephrologist within the prior six months.
• 24:52
  So we have a situation here and by the way, chronic kidney disease will progress.
• 25:00
  much slower if it is treated properly.
• 25:03
  So we have, it's kind of a quadruple aim buster, um, in so many different ways, because we have so many patients who are not being diagnosed, they're not being properly treated, they wind up on dialysis way ahead of their time, which is horrible from a patient standpoint, it's a terrible thing, um, especially too early, and it's really expensive.
• 25:29
  So this is something that the, um, Benefit Corp that I, um, am co president of, we have taken it upon ourselves to try to help.
• 25:40
  And how we do that is we try to identify what I call a golden mean problem.
• 25:47
  This is our whole MO.
• 25:48
  modus operandi here.
• 25:50
  So what I mean by a golden mean problem is what's small enough to solve for, but big enough to actually matter.
• 25:56
  And when it comes to chronic kidney disease, there is actually such a thing.
• 26:01
  It was, it took us like T minus 10 minutes to figure it out.
• 26:04
  And that is that most.
• 26:08
  Clinicians in this country, PCPs and otherwise, are not accurately, there's a, clinically, as per the guidelines, there's a way to diagnose and stage chronic kidney disease that most are unaware of.
• 26:23
  So what winds up happening if they only use The, you know, typical way I would say is that chronic kidney disease patients are way under their, the, the severity of their disease is way underestimated.
• 26:37
  And then what winds up happening is that by the time it's caught, it's bad.
• 26:42
  Um, so one of the things that we're working on is simply how do you, how do we help those who are, have manifestos who are out in the industry who are, who are, how do we help those clinicians?
• 26:56
  And.
• 26:56
  And organizations who really want to do better by their CKD patients.
• 27:01
  Just because you've created a company or an entity, an enterprise to help really enhance and improve CKD or chronic kidney disease, which based on the increase in diabetes, the aging of America is increasingly a massive burden.
• 27:18
  And it could be if treated earlier.
• 27:20
  be better for patients, lower cost for the system, and could enhance families lives?
• 27:27
  I think, so we are working very hard in the CKD space right now.
• 27:31
  The, the, the company QC Health that I am co president of, we tend to choose things where we think that we can make a big difference relatively rapidly.
• 27:42
  And that's how we started working in chronic kidney disease.
• 27:45
  Because there's a great need and to a certain extent, there is, like I said, this golden mean issue, um, where we're getting a lot of, you know, we sort of announced that we were going to be working on this.
• 27:59
  We announced that we were gonna try to work with clinicians and give them a simple resource and tools and help that we may be able to provide in order to improve the outcomes of chronic kidney disease patients that may be in their current patient populations.
• 28:15
  And, you know, just on the basis of the podcast and the number of people that, that we can reach, we're, we're having just an outpouring of like, yes, I will.
• 28:23
  Yeah.
• 28:24
  So we can feel like we're don't get any ideas.
• 28:27
  Dave Stacy's got her own lane at CKD and I could see here.
• 28:31
  Those, those, those, those wheels turning.
• 28:33
  You know, we're doing good whether we're doing well is, um, well, but it's a super important area.
• 28:42
  Well, John, maybe the balance is that, uh, Stacey can do good and others can do well and then it's all balanced out.
• 28:48
  How does that sound?
• 28:49
  The great thing about what she's doing is she can end up doing both if we could figure out how to get it to scale because it really is a massive social problem.
• 28:58
  Stacey, I love the term relentless, you know, as it's applied to healthcare.
• 29:01
  It reminds me of some of the pitbulls that John keeps, uh, around his house.
• 29:05
  But why, why is it so important to be relentless in healthcare?
• 29:10
  You know, you talk about the relentless tribe, uh, that you have, and you kind of help people to, to keep at it, you know, in a relentless, uh, fashion.
• 29:19
  But why is that so important in healthcare?
• 29:22
  I mean, we've been talking about a lot of it here, but like, why that word in particular do you, do you, do you pick?
• 29:28
  I am going to defer to our listeners.
• 29:31
  To answer that question, I get email after email after email from people who say, this is hard.
• 29:37
  This is grueling.
• 29:39
  This is banging my head against the wall in order to attempt to try to figure out how to get my organization to do better by patients or to not do something or to dot dot dot.
• 29:52
  So you have to be relentless.
• 29:56
  It's grueling.
• 29:56
  It's rough.
• 29:58
  Um, and anybody who kind of doesn't, it just, it takes a lot of.
• 30:02
  Grit kind of fighting the machine sometimes, um, to be the one person in the room who raises your hand over and over and over again and says, I don't think we should do it this way.
• 30:16
  Sad to say.
• 30:18
  So I really, really admire all the clinicians, doctors, nurses, administrators, even, you know, everybody out there who is trying to figure out how to do right by patients while at the same time managed to.
• 30:32
  Not get fired.
• 30:33
  Um, you know, kind of like work with and run a sustainable enterprise.
• 30:37
  I mean, again, we've got two great examples of team based care that they're not, you know, are not scaling.
• 30:45
  The one thing we know about patient outcomes at hospitals is they're highly, they're, they're almost.
• 30:51
  It's perfectly correlated to whether the doctor who admits you takes care of you through your care and then it, and then takes you through to the end.
• 30:59
  We know that based on Prescani and other data, we know that very few of our four, 5, 000 ish hospitals actually do it.
• 31:06
  And so just because something's the right thing doesn't mean it's done, which is why I think that relent we, I love, I love the term relentless as well.
• 31:13
  All of us need to be relentless caregivers, patients, and advocates for these, for, for your goals.
• 31:19
  Yeah, I love how you put that and it's just, I hear some doctors who are like, I, I literally have to sneak around to do right by my, like, I know my patient needs X, Y, and Z, and I have to sneak around in order to be able to provide the support that I know is necessary.
• 31:38
  And that's just crazy.
• 31:41
  Not optimal.
• 31:42
  Crazy.
• 31:44
  Well, that's it for yet another episode of Care Talk.
• 31:47
  It has been our great pleasure today to host Stacey Richter.
• 31:50
  She is host of the Relentless Health Value podcast.
• 31:54
  We've talked about everything from her manifesto to kidney disease to some of John's concepts that I still don't quite understand.
• 32:01
  I'm David Williams, president of Health Business Group.
• 32:04
  And I'm John Driscoll, the president of Walgreens Health.
• 32:06
  If you like what you heard or you didn't, we'd still love you to subscribe on your favorite service.
• 32:10
  And thank you for joining us, Stacey.