Episode Transcript
Speaker 0 00:00:08 No welcome. I'm Dr. Robert groves, your host for the groves connection podcast, the groves connection brings you intimate conversations with pundits providers, patients, leaders, and late people all to help us understand a contradiction. How can our healthcare system be both magnificent and yet so deeply flawed. We're going inside healthcare to talk candidly with those who know what they have to say, may delight, surprise frustrate, or at times even anger. But I invite you to get curious and listen to the truth about healthcare and those who want to fix it. Maybe the answers have been there all along. We just need to make the connection
Speaker 0 00:01:16 In this episode, I sit down with San Angela Jane San Angela is among the brightest and most creative voices in healthcare today. And so I was eager to make the connection. Her career began with the health management academy, where she worked with the leadership of the largest and most successful healthcare delivery systems in the country. She's also taught graduate level and continuing education courses in healthcare, economics, healthcare services, research methodology, and health policy at Emory university's Rollins school of public health. And at the center for disease control. Her work is published in some of the most prestigious healthcare journals in the nation, including the American journal of managed care health affairs, the journal of healthcare management and the journal of the American medical association. In addition, she is co-founder of think media, I think tank for healthcare leaders and Dr. Jane hosts, a podcast called per story where she and her guests explored leadership opportunities for women in healthcare.
Speaker 0 00:02:16 She's currently on the faculty at Johns Hopkins teaching courses in digital health, entrepreneurship, population health, and the data informed trends shaping the future of the healthcare economy. She is both an educator and strategic advisor to the senior leadership teams of the nation's largest healthcare delivery systems, as well as fortune 500 pharmaceutical and medical device companies. By now, you can see why I was excited to have a conversation with Angela, but our most recent move may be her biggest opportunity yet as the senior vice president of market strategy and chief research officer for trillion tells San Angela is transforming the way we think about analytics and healthcare, taking a page from the playbook of the largest brands in the world. Trillions seeks to combine an organized demographic psychographic and health-related information to create highly customized predictions about consumer health behaviors and needs at a hyper local level. The result for companies is better service and lower cost for everyone. Brilliant is the information engine of that new strategy and a perfect match for the brilliance and curiosity of a mind like San Angela, James. I invite you to join me now, as I sit down with San Angela at the trillion offices in Nashville, Tennessee, are you ready to connect?
Speaker 0 00:04:06 Angela Jane, welcome to the groves connection. Thanks for having me, Dr. Grips. Yeah, it really is a pleasure. We've we've worked together for a few years off and on when you, uh, were at your position at the health management academy. And we'll get into that later on. Cause I have some questions about your work there and how it influenced you and so forth. But what I like to do is I like to start with, how did you become who you are today? Where did you come from, et cetera. So why not start with telling us where you were born, take us all the way back to birth elementary school day, say, did you know then that you wanted to do something like what you're doing now? Or was this something that evolved over
Speaker 2 00:04:46 Time? Yeah, so I actually grew up in Toronto, Canada, so I am a dual citizen, Canadian American, and as a young child, I mean, I didn't really quite know what I wanted to do, but I aspire to be a physician. And I think a lot of that stemmed from seeing a lot of chronic conditions and my family. So both sets of grandparents had a lot of chronic disease and I had this just fascination with where does disease stem from, you know, how does diet and lifestyle influence that, but also just education because, you know, growing up in an Indian family, you know, this is a different generation, they weren't exposed to things like what does healthy eating mean? And how does that translate to, you know, diabetes?
Speaker 0 00:05:26 Let me just ask you, did you have any frame of reference to anybody in the family? Uh, actually a doctor,
Speaker 2 00:05:31 Not at all. So my, I come from a family of entrepreneurs, all immigrants who came over, started different businesses from, you know, clothing production to transportation, to, you know, finance. And so I was kind of the black sheep that had this odd interest in healthcare or whatever that looked like at the time.
Speaker 0 00:05:48 Yeah. Yeah. So tell us about your, uh, high school days. I mean, where did you go to high school and what were you thinking then?
Speaker 2 00:05:55 Yes, so my family, my nuclear family then moved to Tampa, Florida. And so that's where I did high school. So they shift to, you know, from the cold weather and that's really where I was exposed to kind of sciences. So, you know, I did dance growing up. I did the debate team. I was still thinking about being a physician, but I think it was at that point that I realized, I like thinking about information. So like debate was my favorite thing to do in high school. It was kind of, it was, you know, going deep on topics, really kind of mulling through information. How do you make an argument to kind of convince someone to make a decision was how I was thinking about it. Right.
Speaker 0 00:06:36 Okay. So, so you did most of that research yourself when you prepared for a debate, did you ask for any help from mom, dad, siblings? No. They
Speaker 2 00:06:44 Thought I was crazy that I was spending all this extra time on top of homework to do extra homework. Really.
Speaker 0 00:06:50 Was it a given that you were going to go to college? Is that a value in your family that you get an education and
Speaker 2 00:06:57 Was strongly emphasized growing up? Both my parents went to college, but it was, you know, they came from pretty modest families. And so, you know, for example, my dad immigrated from India and had to put himself through school. And so it was definitely an expectation. You go to college that was no other option, no other option, but actually, you know, growing up, it was the expectation that you're going to also go to graduate school because coming from a family of entrepreneurs, right. You kind of grow up in that risk and a high risk environment, I should say. And so it was, you know, they really wanted, you know, the children to have something more stable or what was perceived as stable, which comes from, you know, you'd be a doctor, lawyer engineer. Right?
Speaker 0 00:07:33 Yeah. I get that completely. So talk to us about how you made the choice on CA how many colleges did you apply to, how did you make your choice there? So
Speaker 2 00:07:41 I, when I need to make a decision, I have to kind of get a lot of information, which is, I guess, why I love doing research. And so I was the crazy kid that applied to, oh gosh, I think it was 20 schools probably. And part of it was just, I didn't really know. And so I would just do research on different schools. I was eager to get into Florida mostly because I wanted to learn and kind of understand, you know, different areas and meet different people. And so my parents said, you know, you can go anywhere you want so long as you kind of figured out a scholarship to support you to do that. And so it was okay, let me apply to as many schools and kind of explore my options. And in the end, gravitated towards rice, which is a school in Houston. So
Speaker 0 00:08:20 What was it about rice that attracted you? It was,
Speaker 2 00:08:23 I remember going to campus and it was this gut instinct where it was such a small family style environment, but it was very entrepreneurial. So for an undergraduate experience, you know, this most schools have a strong graduate presence. And so if you're studying the sciences, which is what I was planning to do at that time, you're just kind of supporting the graduate students. But rice was unique in that it was primarily an undergraduate focused institution. And so what that meant is that it was really big on experiential learning. So if you were going to do research as a student, you're basically going to have the workload of a graduate student. So I was able to publish papers as a sophomore in college and working directly with faculty that in a lot of other schools, you know, you'd probably be supporting a graduate student and maybe being, you know, sixth or seventh author on him. Yeah,
Speaker 0 00:09:06 Yeah. Now, now I want to stop you for just a second. So you're talking about a bachelor's program and you're actually publishing first name, author work. What kinds of things were you publishing at that
Speaker 2 00:09:17 Time? Well, the second part of why I wanted to do rice was because it was right across the street from the Texas medical center. And so a lot of the research I was doing was actually at the intersection of psychology and the clinical practice. So
Speaker 0 00:09:30 For folks who don't know what Texas medical center is, give them a little bit of the flavor of, of what that's like to be in the middle of all that. How many institutions are there? I, I, I don't even know
Speaker 2 00:09:41 I've lost count, but it is officially the largest medical center in the world. And so it's like a mini city. Like it was right across from campus. You walk in there and it's, I mean, just medical institution after institution. Yeah. There was the Ben top community hospital right there. And so my, you know, I did a lot of different things, but my research was primarily with MD Anderson. And so it was in this division called human factors, which at the time, I didn't know what that actually was, but it's a study within psychology, which is basically how do you look at interfaces and kind of the design of things that influence how to make decisions. Exactly.
Speaker 0 00:10:16 So human factors engineering is essentially what you were publishing on at
Speaker 2 00:10:20 That point. Or so I lucked out the PI that I was working with basically was we were working with MD Anderson to create this was before iPhones were heavily popular, but it was the M Dawsey, which was the MD Anderson symptom inventory. And so it was taking paper records of when cancer patients would come in the door and kind of say, you know, on a scale of one to 10, how tired are you? And it was just, you know, 20 questions, one to 10 you'd have to rate them. And there were paper forms and the nurses were having to input this into the computers manually. And so this project was basically taking one of the early versions of the iPads and turning to visualize trend information for those symptom surveys over time. So that when the patient came back for visit number 10, the physician could actually see, okay, I see that from last visit, you've gone up or down. It's
Speaker 0 00:11:10 A fascinating place to start. So if I understand correctly, part of the process was that they were moved from filling out a paper form on arrival or on admission or wherever this was in the process to using a tablet so that you could capture it as data.
Speaker 2 00:11:26 Absolutely. And so it was the data collection process, but then from a human factors, point of view, it was actually, how do we make that data usable on the receiving end for the provider who needed to use that data to figure out what the patient actually needed
Speaker 0 00:11:41 You very early on. We're thinking about how do we turn data into information is the way I like to think of it.
Speaker 2 00:11:47 Yeah. And it's funny until we've had this conversation. I never really put that connection together, but yeah, that really was my first foray into that.
Speaker 0 00:11:56 That is, uh, I had no idea that you had gotten into it that early. So you've got your degree now you've had some experience in turning data into information. Are you still thinking I want to be a doc.
Speaker 2 00:12:07 Yeah. So the quick story is I was also an EMT in college thinking, Hey, let me get some actual clinical experience. So did all my shifts over at Ben Todd?
Speaker 0 00:12:17 Yeah. So wait a minute, you were out there intubating folks,
Speaker 2 00:12:21 EMT basics. So I couldn't do all the advanced things, but you know, do the ambulance ride saw a lot of patients with substance abuse, you know, a whole range of cases there, which was really great for me to get a really a pulse on what clinical care was
Speaker 0 00:12:34 Really your first view of actual. It
Speaker 2 00:12:38 Really was hands on because to your point earlier, I didn't grow up in a family where I had that exposure. So I didn't really know what clinical practice looked like beyond going to a physician pediatrician as a kid.
Speaker 0 00:12:49 So how did that influence your decision making, do you think?
Speaker 2 00:12:52 I think that's where I started putting the pieces together that there's so much wrong in the system because I would be on a shift at 3:00 AM trying to admit a patient into the ed and, you know, with see all the paperwork that was needed or seeing the lines or seeing, you know, the care transitions. And I wait and I didn't know enough. I mean, at that point, I didn't know the difference between Medicare and Medicaid. I really didn't, they don't teach you that in undergrad. So I didn't have the full concept of how big the problem was, but I was seeing those in pieces. And then I was thinking about information and how physicians were looking at the paper charts to figure out what was happening before being through. So I was kind of seeing this, and then I was thinking about my family in Canada and how they had access to a government funded system and how they were getting all this care that they were constantly raving about. And I'm trying to understand, okay, so how is their system different than our system? So I just kind of had all these questions and I didn't quite put the links together. My answer at that time was still medicine because I was committed that it was healthcare. In fact, that I wanted to be in that space. Even
Speaker 0 00:13:52 With that early exposure, it was obvious to you that it wasn't functioning as well as it could, or perhaps should. Yes. And so you didn't go to medical school. What happened?
Speaker 2 00:14:02 I still had this, you know, and get that gut feeling or like there's still something feels unsettled. Like I didn't have all the information I needed. So the last experience in college that was really formulative to me, and this is why I'm so grateful to rice because they truly treated you, you know, eight us, what 18 year olds as real adults in many ways was I actually saw my first board of trustees experience. I was student body president and I got to be in the board room with no university president and all the trustees. That's where I started seeing. Okay. So how are decisions made at an organizational level? And so that's when I really knew. Okay. So I'm seeing these clinical gaps on the frontline as an EMT. I'm seeing, you know, data and information being kind of big void here, but now how do you fix that? Okay, well here's how decisions are being made and, you know, it was also a psychology major. So I'm just generally fascinated by how people think and, and make decisions. And so all the say I went on this process of probably doing 60 informational interviews. And so I said, well, I don't know what I want to do. Post-college.
Speaker 0 00:15:00 So before you decided what you were going to do, you interviewed 60 people. Yep.
Speaker 2 00:15:07 I basically would just go to anyone I could think of and say, do you know anyone who works in healthcare, whether they're a physician or a did lab science, whoever you are. I just said anything broadly healthcare introduced me. So I had decided that I was going to go to medical school a year later and I was going to take this gap year. So I could really figure out where in healthcare I was, I was trying to fit the pieces together. I wanted to have this industry experience. Yeah.
Speaker 0 00:15:30 This has given us some great insight into how your mind works. And it's a little scary. I got to tell you this, Angela, I just, that level of attention to detail at that age is remarkable. I, it, did you come by that naturally? Is that just the way your mind works or was there something in your upbringing that led you to, to think about things that way?
Speaker 2 00:15:51 The best thing I can think of is just the influence of, of people. I think I'm a better listener than talker, and I just love learning from people. And I am just fascinated by every individual story. And so for me, it was growing up in a household where we socialize a lot. We entertained a lot. It was, you know, the whole Indian community was invited over to our house for dinners. And you know, my first birthday party as a child, just to paint this picture had 300 people at my grandmother's house. Now, were
Speaker 0 00:16:15 You the kid that was walking around asking everybody a bunch of questions? No about
Speaker 2 00:16:18 That. But just saying that I grew up in an environment where I was always around people and always, you know, was striking up a conversation. And, you know, I think that part of me was kind of there from an early age. And I said, well, why don't I try to just learn from other people because you can't Google this stuff and there was no textbook for it. And so just, you know, I love coffee and I would just go sit at a coffee shop and go have a bunch of coffees with folks. And it wasn't until I'd actually accepted a job offer through one of those connections, thinking I'd go more on the business consulting side. I want to point
Speaker 0 00:16:52 Out something here because it's fascinating to me. And, and, and I've had sort of the same epiphany as I've been doing. A lot of these interviews is wow. You know, those connections are so critically important and that may not have been what you set out to do. It wasn't a networking thing you were doing, you were asking legitimate questions to help you decide. But in the process of doing that, it is impossible to avoid making connections with people. And those connections can sometimes lead to some really fascinating things. And you're going to tell us what that thing was.
Speaker 2 00:17:24 Yeah. Well, just to that point though, it's a really good point. So I actually really hate the term networking because there's something there's something about. No, no, but I think there's something about it that feels superficial to me. So to your point at the time, I wasn't thinking of it as networking. And I had a lot of my classmates who were on the business track and they were saying, I'm going to a networking event to meet these people. And for me, and maybe it was a psychology major me, it's like, I just really want to get to know these people. And the questions were never about me. They were always like, what do you do? And how did you get there? And what did you study? And, you know, and so it wasn't later that I realized, I guess maybe that isn't networking or it isn't, but there's this connotation that it's networking means you go to an event and you try to get a bunch of business cards.
Speaker 0 00:18:08 Right. It's the intent that is very different. And I would wager that it's a much more authentic way to make real connections with people rather than feeling like somebody's shaking your hand because they want to get something from you. Right, right, right. Yeah.
Speaker 2 00:18:22 But yeah, to your point, I went into a blind and I was just looking for insight and have these conversations. And so thought I would stay in Houston and try out consulting for a year. And then it was just a couple of days before graduation. So I had made all my plans and I got connected to actually a colleague that we both know Jarrett Lewis. And we had a mutual friend that was working on the political polling for a presidential campaign. And so spoke with Jared. And I said, well, so what do you actually do? And, you know, what's this company that you work at. And we had a really great conversation and he probably used a bunch of terms that I, once again, didn't know anything about, I didn't know what value-based payment or integrated delivery network actually was, but I was just fascinated with this organization that he described, which was the health management academy.
Speaker 2 00:19:07 And it was this group up in DC that once again, DC was not on my radar because I had the stereotype that DC was kind of this policy Capitol. And I didn't know anything about policy. Next thing I knew, I was talking to one of the co-founders and CEO at the time, Gary Bisbee, who you also know very well. You know, I remember Gary calling me on a, on a Saturday, probably a 7:00 AM call. And so I get on the phone with him and he starts asking me all these questions couldn't even tell you what they were at the time, but I'm pretty sure the answer to a lot of them was, I don't know, you know, there were things like, what do you want to do? How do you think about the future of health policy? And like I told you, I, I really didn't know the difference between Medicare and Medicaid at the time.
Speaker 2 00:19:48 And, you know, we were just talking about different things and I probably did my thing and just asking him questions. Okay. So what is this company that you've built? What is your degree? And next thing I knew, you know, I got an email saying, you know, Dr. Busy would like you to come to DC. Don't really have the context for what I'm going for. But I show up to meet with Gary and he's planned this whole day for me to basically meet with, you know, 20 people in the company at the time the company was very small. So there was, I met probably every person in the organization and just had conversations all day. Perfect for you. And they're all like, why are you here? And I said, well, I don't really know, but tell me about what you do at the end of the day, you know, about a fly, fly back home.
Speaker 2 00:20:27 And, you know, Gary says, well, we're not really hiring, but you know, what did you think? And I said, oh, I know, I know you're not hiring. I'm not looking as well. We, we also don't hire anyone on the content side without a master's degree. And I said, yes, I'm fully aware. I don't know the difference between Medicare and Medicaid. So it makes total sense to me. He said, well, I'm willing to mentor if you're committed to kind of learn and, you know, kind of resulted in kind of creating a role for me. So a theme in my life is I've, I've never had a real job description. I've always kind of written them myself. Um, and we kind of created this fellowship position where I worked directly for, for Gary and the bargain was basically I supported him in any project that he needed. So I traveled with him when he was meeting with CEOs to, you know, working on research projects. And that was my applied master's degree, you know, for
Speaker 0 00:21:16 Listeners who don't have a good grasp yet on what the health management academy is either there for Helen
Speaker 2 00:21:22 Five years, five years.
Speaker 0 00:21:24 Can you give us a thumbnail sketch of what the health management academy is?
Speaker 2 00:21:29 Yeah. So the academy really is what I'll call a network of the largest 100 health systems across the country and their senior leaders. So it was bringing together
Speaker 0 00:21:40 Specifically hospitals,
Speaker 2 00:21:41 Hospital companies. Yes. You know, it was really what this premise that the priorities and strategies of the largest hospital systems were fundamentally different. They had to think differently than running a physician practice or running a single hospital in one area. And so with that thesis, it was this idea of let's bring together the leaders of those organizations so they can learn from each other. So you'd have to bring all the chief medical officers like yourself together and say, okay, so what are you up at night thinking about how are you approaching it? It was really this close knit community. If you will, you know, across the country where you were bringing together all these leaders with trying to solve the same problem in healthcare, but from different organizational perspectives.
Speaker 0 00:22:23 Yeah. It was a, and it was an organization that was very formative for me at that point in my career, because I had, uh, jumped into a role that I didn't understand very well. And you had gone from being a practicing physician to an administration for lack of a better term. And I wasn't quite sure exactly what I was supposed to be doing, but I knew I had the opportunity to learn a lot in this situation when Dr. Henson gave me the opportunity to participate in, and Gary was kind enough, uh, with the committee there to accept me into one of the fellowship roles. And HMA does fellowships now for just about every, uh, senior level in a healthcare system. When the other CFOs CEOs, board members have a regular meeting, that's not really a fellowship. It's more of a meeting of the minds, you name it and they have a program available for it. Now you say on and off for five years, tell me what the off things were, describe that period in your life.
Speaker 2 00:23:21 Yeah. So the first role was this fellowship, which was, you know, really my, I was a fly on the wall on all of these really important conversations where I was just absorbed, absorbing and learning. I really was. And, you know, not only from a healthcare point of view, but also what it took to run the organization kind of build a business, was the other lens that I had. So at this point in medical school, I realized was even further and further away from what I wanted to do. I was still committed to healthcare. And I, how did you
Speaker 0 00:23:47 Make that transition? Because you'd been focused on being a doc since you were in elementary school. So walk me through how that shift occurred and what was the deciding factor for you because you're somebody who does your homework, right? So I'd love to understand that transition in your thinking
Speaker 2 00:24:04 If it was in that first year, that's where I realized, I didn't know what a chief medical officer was or a chief operating officer was. And so I think at that point, I said, wow, there are so many different ways to influence the system without having a clinical degree. If I was at a chief medical officer forum, I would talk to a bunch of the CMOs and say, okay, so tell me about your path and more than just your path, what do you do? What, you know, what are you actually responsible for, even if it's more administrative, but what types of decisions are you thinking about? And I would have the same conversations with the COO's and the chief strategy officers and what a great
Speaker 0 00:24:41 Context to get a broad exposure in an environment where everybody is essentially relaxed in sharing information with peers, mostly noncompetitive peers. Uh, so that's, that's a great way to get an exposure to a broad range of, of healthcare opportunities. Is this all happening in the first year or two?
Speaker 2 00:25:00 This is all in the first year. And then at that point I'd made the decision going to punt the medical school thing, but there was still this, I still wanted to have a graduate degree. Right. But I also knew, so you went and got a master's right. I, I thought about it, but it was, you know, then I had all these, everybody was saying, well, why don't you get an MBA or why don't you get an MPH or an MHA? And my thing was well, but I need to feel good about why I'm getting the degree. It's a means to an end for what gotcha. And the best advice I ever got was, you know, graduate school really gives you a framework for how to think. I really was laser focused on that. So what type of exposure or training was I trying to better understand? And I, I still needed more time to figure that out. So I knew it was gonna be graduate school. I wasn't ready to go at that time. I was really enjoying the work that I was doing. I was lucky enough to be promoted, to basically run the educational group for the CEO and board of trustees group, which is kind
Speaker 0 00:25:58 Of the, wow. That's kind of like a, you know, getting an assignment that's right at the top right off the bat. Huh.
Speaker 2 00:26:04 I've been very fortunate. It's, it's funny. I think I've only exclusively worked for CEOs. So I don't know how that is panned out from, from first job to current job,
Speaker 0 00:26:12 You know, how to manage egos among other things. But go ahead.
Speaker 2 00:26:15 I think part of that fascination came from sitting in the board of trustee rooms back in college. I just, I think I've had a very unusual young person experience where I've just always been around CEOs and trustees. And so I somehow landed on this idea of maybe I should get a PhD. What's funny about that is I've never considered a PhD before because the stereotype around it is that you're doing bench science and you're just kind of in the weeds and you're not dealing with. And the only career path is academia. And I wanted to be at the center of action and I wanted to actually influence decisions. So it just didn't quite line up and make sense to me. But as I met the handful of PhDs that were more in the applied setting, you know, Gary was an example of that who had a PhD in chronic disease. And so it was now an entrepreneur. And so I met a handful of PhDs who were kind of technically trained, but they were working really at the front lines of the industry to help inform decision-making. Yeah.
Speaker 0 00:27:13 And so at this point you don't have a master's in anything you've got a bachelor's degree. Gosh, I didn't know. You could skip that step and go straight to the PhD. How did you figure that out? And, and is that true for most people? I think not,
Speaker 2 00:27:26 It's not. So once again, I'd kind of made this decision, you know, I want to get a PhD on the whim, but I'm also a pretty impatient person. And so, so, well, you know, I want to spend two years getting a master's when I kind of know ultimately, you know, what it is that I want to do well,
Speaker 0 00:27:40 You'd had sort of a master's equivalent, as you mentioned
Speaker 2 00:27:42 Earlier. I mean, I kind of felt like back to if I'm going to get a degree, why. And so when I would do research on an MPH, for example, well, it was really learning kind of about the U S health care system. And I said, well, I kind of already, now I know a Medicare and Medicaid is, and I know what, you know, hospitals are, and I know how they work with insurance systems. So I felt like I had already gotten that knowledge more or less. And so I kind of said, well, I'm just going to apply anyways, to be honest about time. I wasn't really thinking about getting in. It was more about maybe it'll help me learn about the process. So it's really a self-reflection exercise more than anything.
Speaker 0 00:28:19 Interesting. Yeah, this is, this is right up your alley.
Speaker 2 00:28:24 And, you know, a couple schools reached out and they said, got a really interesting perspective. And, but we don't take students without a master's degree. So how about you consider doing our master's program and, you know, so I entertain those conversations and I would do the site visits and meet with the faculty just to learn once again about the programs that they were thinking about and the research questions they were exploring. And so some programs were slightly more clinical quality oriented, some were more access related to Medicaid policy. So it was helping me actually think through, okay, here are the range of issue sets in health care, but if I'm going to do a PhD in some ways you kind of have to focus in on one, once again, through a conversation through a couple of schools, you know, they said, well, but you're, you're not, you're a nontraditional candidate because they had recognized that I had this applied experience.
Speaker 2 00:29:10 You know, I said, look, I, I recognize that I don't know the first thing about economics. So I don't really know much about coding and programming on the data side, I felt like I needed a technical skillset to ultimately connect the dots between what I was hearing and those, you know, HMA academy meetings where you had all these decision makers thinking about strategy. But then what I was reading in the literature and kind of what the scientific papers were saying, like there's felt like this gap. And so I said, I want to get a degree that can help me understand how to bridge that. And so found my way to Emory. And, you know, they took a chance on me and we had this open conversation where we said that I was going to come in, you know, not having the baseline that other students would have and that my path would be harder.
Speaker 2 00:29:55 And I remember the first day the program director sat me down and said, you know, the average year time for completion of a PhD in health economics, health policy is five years. The superstars around here usually finish in four. You probably should plan on being here for six or seven. And at that point I didn't mind. I said, okay, I'm in it for the long haul because I know why I want to do this. I see the questions, the problems out there. Now I want to figure out how to help solve them. And I need this degree to help me, you know, get that conceptual framework to do
Speaker 0 00:30:26 That. It's fascinating to me is I have always had a great deal of respect for the PhD because it's open-ended with, with an MD, there are hoops and some of them are tough hoops, but all you gotta do is jump through them. And if you keep jumping through the hoops, you're going to get your MD degree with a PhD. There are so many other factors involved and there's no set time limit. Uh, I just have a lot of respect for, for anybody who gets that degree and to get it without going through the process of being in a, uh, you know, the master's program, the graduate school is, is must've been kind of scary.
Speaker 2 00:31:01 It was, I would say it was probably the most difficult things that I've ever done, but also the most rewarding. I mean, it was, I was the black sheep and my program director was right by calling it out. I mean, you know, I was someone who had come from industry and it was kind of unheard of, okay, so frowned on a little bit. Yeah. A little bit. It really was. And it was like, well, do you know how to program and state and all of that at that time, it was like, well, what is data? Right. So, you know, I think a lot of people were skeptical and it was really hard. But what I've learned is, and you know, this as a, as a physician, like when you have a purpose or mission of what you're trying to achieve, you figure out how to have that guides you through all of that. It does, you don't deviate from it. So that kind of keeps you motivated through all of it. So, yeah, there were tough moments where I'd sit in class and I had no idea what was happening and, you know, but I just did whatever I needed to do to make up the difference. And in of, yeah.
Speaker 0 00:31:54 So you got your PhD. If anybody deserves to be called doctor anything, it's you. So from that point, you've got your PhD. Now, now is this happening while you're still working at the academy?
Speaker 2 00:32:06 No. So at this point, so this is the on and off. So at this point I decided time to go to grad school. So I left the organization, moved down to Atlanta for the program. Full-time for how many years? Three years actually.
Speaker 0 00:32:18 Oh my gosh. Okay. Now I'm getting a little bit envious. So you got your PhD in three years when they suggested to you that six or seven might be a better estimate. And now what are you?
Speaker 2 00:32:27 Yeah, I actually was thinking, I'd go to a, what they called a research Institute within one of the consulting groups. And so I was having those conversations. And so it was gearing up to do all of that. And then next thing know, I get a call from Gary and the academy was going through a transaction. And so they were doing a deal with Welsh, Carson Anderson and Stowe, which is a leading healthcare and technology PE group. And they were going through a transition. So how do we now take this incredible platform that, you know, the co-founders had built over the last 20 years and really figured out how to support health systems and their partners beyond just the convening and think about research and how policy and additional programs and areas of investments basically asked if I would come and help them build their first kind of research P and L if you will.
Speaker 2 00:33:15 Cool. And I said, well, you know, once again, I think there are a lot of parallels between doing a PhD program and kind of being an entrepreneur. And I was really thinking about it. Well, you know, I was in my twenties and you know, what else am I going to have an opportunity to build a mini business if you will. And if it doesn't work out, you know, I can always go back to the big company. That option is always going to be there, but the opportunity to do something at a specific point in time of a company's evolution, that's pretty rare and unique.
Speaker 0 00:33:45 When was this? What year is this? That this was a huge transition because the co-founders had led this organization for decades, right? And now they're making a big transition and there's going to be new leadership and they call you in to help build, uh, the research side of that organization is that kind
Speaker 2 00:34:06 Of thing it is. And, you know, part of the thought was, in some ways I was this odd bridge between kind of the old, the old guard and the new guard, because it was really important for the board to have someone that understood the core principles of what made the academy so special in terms of the member experience, but then also understood the research side and the business side in a way that could bring in these new ideas. Because one of the areas, we did a lot of different things of survey research, basically in my view, as an extension of peer learning. Right? So if you're not at a meeting with your fellow chief medical officers, cause you're only meeting twice a year, well, how do you share information? You know, all the other weeks of the year. And so here's where surveys and interviews come in, where you can start saying, okay, well here's how banner is thinking about it versus here's how Advent's thinking about it. And you can kind of use data to extend that conversation. We use a lot of survey research to, to educate is really how I viewed it and figured out a commercialization strategy. And it was really fun to kind of come up with what does research look like? And then you had the operational side of it, right. Was, you know, bringing the team that you needed to do that and, and figuring out what that looked like for a division that has never existed before. And so figuring out as you go. Yeah. You know,
Speaker 0 00:35:22 And, um, I'm thinking about the time span between the early two thousands and the late 2010s, I guess a lot of stuff happened in healthcare. I mean, there were some huge transitions along that path. And so it wasn't as simple as we've got a stable industry and let's have, you know, fit this piece to that piece. I mean, you had to really think not only about, uh, how to blend those two cultures, how to create something new that didn't exist before, but also how to do that. Uh, you know, the analogy is, is probably tired, but it's like, you know, building an airplane while you're flying it kind of thing. Uh, and I don't know, that gives me a good enough visual that I understand the complexity and the difficulty of that task. And that's kinda how this must have felt.
Speaker 2 00:36:04 I'm laughing because if you were to go back and ask my team, I would say in every team meeting, I probably made that analogy and really does that. I had never heard it before, but that's really what we were doing. I mean, a lot happened in a very short amount of time.
Speaker 0 00:36:19 It really did. And I'm following along here and I've, I've, uh, I think I understand the, the path that you took and there is one fundamental that's, that's, uh, true at each step along the way. And that is your curiosity and your ability to connect with people and in the process of asking legitimate questions that you want answers to create relationships along the way that obviously have served you very well. So you, so you were at the health management academy until,
Speaker 2 00:36:51 So I was there through about April of 2020. So this has just been very recent yet and it was unplanned. And so like every once again, I'm learning it's as a theme of my life. And so back to, you know, not creating job descriptions, you know, the pandemic was really interesting because it really shook up the industry for many reasons. But one unique opportunity came about actually from Hopkins, you know, they had called saying, we need to now go everything online. And our faculty don't have that experience and said, well, I've never taught online either. But what was interesting is that the medical school at Hopkins was going through this evolution of, to basically help our physicians kind of prepare for this future. And I think the pandemic really accelerated this. And so long story short, one of those key areas that they had identified, it was digital health entrepreneurship, which is funny because I really know nothing about digital health, but their goal was trying to bridge the silos to say, well, there's all this innovation you tech companies that are trying to solve very specific clinical needs, whether it's, you know, the Omada type model or Virta type model.
Speaker 2 00:38:02 Right. And so, but ultimately they have to reach patients through the care delivery mechanism. And so I was asked to kind of bring this systems view perspective to help paint the picture of what are the policy trends, what are health systems thinking about? What are payers thinking about?
Speaker 0 00:38:19 Let me ask you, was this the first time that you're really getting into predicting the future of health
Speaker 2 00:38:24 Care indirectly? I mean, I think through my previous work at the academy, when presenting research, I ended up doing a lot of presenting to boards of health systems on, you know, here are some of the trends, you know, from a data point of view, I was doing it in a very, to your point. I mean, I had never really thought about, I don't have the insight to predict the future, but I can tell you what I see today in terms of what the data is showing or, you know, what I'm hearing in the industry from surveys. And so we see the silos in healthcare, and I was realizing that I was working in a silo that some ways, right. I, I was only in conversations primarily with health systems and I said, well, maybe I need to branch out and learn more about digital health companies.
Speaker 0 00:39:03 Can I take a guess? You started talking to people and doing
Speaker 2 00:39:08 Research. Yeah. So I just started reaching out to different, you know, founders of companies and built this curriculum. And so, yeah. And so,
Speaker 0 00:39:16 Uh, how long did you do that? Are you still doing that? Or, you
Speaker 2 00:39:19 Know, so pandemic made us all work a lot more. And so, you know, through conversations, you know, and planning for the course and, you know, talking to founders, it led to different pieces, started coming together. And I was being asked to do a lot of, you know, let's just call them consulting projects, speaking with different teams of different healthcare companies to help them understand, okay. During COVID here is, you know, what the, where the policy trends are going, whether it's, you know, tele-health reimbursement changing or, you know, here's where some of the investments in digital health are changing. So it was kind of using information and data and kind of connecting it from different places, a little bit of a secret coming out soon, but was asked to, um, got a publisher contract to do some writing. And so there'll be more on that coming soon. But part of that was to, you know, to your point about trends is what does the post COVID health care landscape actually look like?
Speaker 0 00:40:12 Yeah, well, you'll have to let me know when that writing is complete, because I'd love to have you back to talk about that. Yeah.
Speaker 2 00:40:18 So I should have more updates for you at the end of the year, but that's a big project that I spent a lot of 2020 working on. So a lot of pieces kind of came together. And so really spent a lot of time heads down, working on a lot of these things, thinking about, you know, the different trends across different silos of the industry.
Speaker 0 00:40:36 And then we'll get back on track. How did you learn to write and what did you learn about yourself? You know, is there a time when you do your best writing, do you do it in a certain way? Is there a process you go through
Speaker 2 00:40:47 Say, I am a writer in progress, so I never really formally trained or learned it, but I think once you have to write a dissertation or write debate cases back in high school, you just have to do a lot of it and do a lot of it pretty quickly. And so a lot of it for me has been writing under pressure, believe it or not. And so I write best in shorter periods of time versus by say, you know, I've got six months to write something. I'm not going to make a lot of progress. So I have to say, you know, at the end of this week, I've got to write complete a, B and C, but I'm a morning writer. So my best writing, this is actually how I wrote my dissertation. I would write from 4:00 AM to 8:00 AM every day. So those are my peak, uh, writing hours. And
Speaker 0 00:41:31 That's when your highest creativity and energy happen or is that because you feel like you need to get it behind you. So you can, because the time that you're writing is interesting to me, because most people are starting their day around eight, right. And you've got a big piece of work under your belt by the time that comes around. Is that part of it?
Speaker 2 00:41:49 I had never thought about that actually. I mean, part of it is just I'm my mind is clear in the morning. So it's kind of getting all these thoughts out, having no distractions because I,
Speaker 0 00:41:58 You know, distraction and,
Speaker 2 00:42:01 You know, I, when you're trying to procrastinate from writing and you're stumped on Southern thing, your instinct is to look at your phone or check your email. But at that time of morning, nothing is really kind of coming in. And so it's really kind of my window to, to really force myself to not think about anything else besides what I needed to write
Speaker 0 00:42:19 About it is intrinsically protected time in a way. Yeah. Yeah. Fascinating. I'm fascinated by how people write and when they write, and it's not unusual to hear people say that they do it in the morning, usually not quite that early in the morning, but it's typical for many of the writers that I've spoken to for them to set aside time in the morning and not do a nine to five for six weeks kind
Speaker 2 00:42:42 Of thing. And the fun fact on that is, you know, even on a weekend. So you would think during the weekdays, you know, when you've got a lot more happening, that's why you have to compress it in the morning. But I find, even if I have a full Sunday free, I still have to write at that early time in the morning and I still do it. Now, I know what we'll talk about. You know, the blog that I write now with trillions, but even that sometimes I have to still write it in the morning. Yeah. And
Speaker 0 00:43:06 For our listeners, tell them about that blog. Cause it's, it's got some fascinating stuff in it and I've enjoyed just over the last several weeks to months. Can't remember, but I've really enjoyed that. So, so tell us how we can find
Speaker 2 00:43:19 That. Yeah. Thank you for that. So, um, it's called the compass and the compass actually was this idea that originally no, during COVID. So, as I was having these conversations, doing a lot of writing, thinking about, you know, how to give people information, to make better decisions, you know, I've never been myself as a consultant because I don't have the expertise to tell anyone how to run a hospital or you know, how to create drugs. That's just, I'll never have that expertise nor do I have the interest to do that. But I view a lot of my role as how do you bring disparate pieces of information and present it in a way that might provide some context for, for someone to kind of keep in mind when they're making whatever decision they need to make. And so the origin of the compass is really, so the compass was kind of this quirky thing where I felt like, what am I actually trying to do?
Speaker 2 00:44:06 I'm trying to guide people. I, I'm not trying to kind of tell them what to do, but I'm trying to point them in a direction. And so that's how the name kind of came about. And so, you know, it's a little subtle, but that was why I named it, named it that, and it was, you know, being a researcher, I think a lot about data as that guide. And so it's a weekly newsletter that goes out Sundays and it's purposely intended to be pretty short. And the format is really supposed to be what I call data stories. So how do we look at a couple of trends happening in the industry, but I can back it up with data to kind of tell, paint this picture of something that's happening directionally.
Speaker 0 00:44:49 And then so, so there might be at least in a technical sense opinion, however, it's backed by specific data that drives that impression. Is that okay? That's right.
Speaker 2 00:45:00 So I actually always focus on the data trend first. It's actually something that I learned from one of my PhD. Mentors said, whenever we start doing research, or we want to write something or, or make an argument about something, draw the picture. What is your hypothesis of what you think the trend is, or, or what you're expecting to discover? For example, we just wrote about Walmart and it's, you know, what does it mean for healthcare? What data is available about Walmart? What do we actually know as relates to healthcare? And, you know, you could think about reading their financial statements, you know, got to think about how much revenue is coming in from healthcare services. You could think about geography, where are they located? So I usually kind of start with these different aspects or metrics related to a topic and then go out and try to find that data, create that story, look at what the trends actually are, are telling us. My original goal was to keep it at 250 words that is kind of, it's been flexing between about 350 to about 600 words, but really just to state the, the trend, like to define it and quantify it, and actually very little opinion. It's mostly just to say, this is happening and this is what I think it kind of means directionally, but interpret the data as you will, for what, whatever vantage point in the industry that you sit in.
Speaker 0 00:46:18 You just shot down my next question. I'm going to ask it anyway. It is impossible. At least I believe it is for us as human beings, not to have some notion of what we think something means, right? And I want to understand if when you look at that data and you come up with a hypothesis, is the next step trying to prove yourself wrong or trying to prove yourself, right.
Speaker 2 00:46:40 I'm probably a bad researcher in this regard because what you're asking is the typical scientific method, right. Where you should actually formulate a hypothesis and develop that it
Speaker 0 00:46:51 Was a trick question and you, uh, wriggled right out
Speaker 2 00:46:54 Of it. But, uh, I'll say I need more information. I may not use all of it, but I'm trying to bring it from, you know, if it was 20 articles and there might be, you know, two words in each of those articles that trigger a thought, I kind of need to absorb a lot of it. So it's less about having a hypothesis for me. It's more about, oh, reading this set of data or this interesting trends. Like I think I see a pattern here. I try to challenge myself to say, is there something out there in the data that we have not even kind of identified as opposed to showing a relationship between, you know, a and B that's
Speaker 0 00:47:25 Very interesting. Yeah. And, and, you know, the punchline is that most people will start out trying to prove what they already believe. What I hear you saying is you're just following a data trail and seeing where it goes for the most part, the best diagnosticians, by the way, are not the physicians that quickly come to a hypothesis on what disease the patient may have, the best wins, leave their minds open for the longest period of time. And in it, I just think it's a good practice to remember that we are so prone to self-validation and ignoring data that doesn't agree with what we're thinking and overemphasizing data that does agree with what we're thinking. You kind of skirt around that whole issue by saying, look, it's not that I want to make a hypothesis. What I want to know is what's going on. So I'm curious, and I follow a data trail and then I present it to everybody. I pull pieces from different areas, pull it all together, uh, in, in a coherent package, present it and say, what do you think about this?
Speaker 2 00:48:27 It's a really good point. I had not thought of it that way, but you're right. And part of it is I'm such a visual person. And so the origins of this really where I can't even, I can look at a spreadsheet of a bunch of data, whether it's claims data or financial data. And I could never really put to, you know, some people can look at a spreadsheet. They could say, oh, that that's going up or it's going down. And it would take me hours to come to that conclusion. And part of is I'd have to plot it out or draw it and sketch it out.
Speaker 0 00:48:56 There's something about the physical engagement with the data that, that helps you learn it essentially. And are you still teaching at Johns Hopkins
Speaker 2 00:49:02 Now? I am, but I've scaled back because, uh, so once again, the next opportunity kind of came out in the progression. Yeah.
Speaker 0 00:49:09 Yeah. I want to get to that one. Let's talk to us about that opportunity.
Speaker 2 00:49:12 So, you know, as I was having more conversations and, you know, people were asking for what data trends are you seeing? And I was, you know, literally getting ready to start writing this newsletter because I felt like that was my way of scaling the insights and information across, you know, different stakeholders. Once again, you know, when those opportunities arise, you're like, well, what is it that I actually want to do again? And, you know, you start, you know, reflecting again. So this, this friend and mentor, you know, said, Hey, it sounds like you're thinking about data in a very different way where you're now trying to not just do survey data, but really think about market data and kind of think about the variation in context, because the thing I've been trying to chase after for so long is how do people make decisions, right? I'm trying to figure out how to equip people with the right insights to do that. What data do you use? And for a large part of my career, it's been it's opinion data because someone completes a survey and they say, this is how I am thinking about
Speaker 0 00:50:03 It, the top executives in such and such an industry believe. Yeah.
Speaker 2 00:50:08 Right. So, you know, CEO of organization, a believes that, you know, this is going to be the trend CEO B believes this, and that's really valuable perspective, but how do you know, like what's the, the wraparound information that you need to actually make the decision to know that see if cob copied what CEO EY was trying to do with that FactSet doesn't translate over to that market or that organization or that patient population. He's a, isn't
Speaker 0 00:50:37 There a whole, uh, an issue around group think as well. I mean, I can't remember the name of the author that looked at predictions and, and what he discovered was that there are some people who are very good at predictions. They're usually not the experts. Part of the problem is once one guest, so immersed in a single role with a single set of data at a single set of colleagues, it becomes very easy to frankly see things that aren't. Yeah,
Speaker 2 00:51:03 I think a lot about this idea of best practices. And I think that's what our industry gets wrong, whether it's treating a patient or making a strategic decision, but there is no best practice because every scenario is different. And so the best practice, the clinical literature, not to simplify it right. But would say, you know, take your medication at this time, eat this, you know, whatever those things that look like, but where is the customization and what are those nuances that have to be tweaked to adapt to that individual patient's preferences?
Speaker 0 00:51:34 Okay. I mean, I'm going to push back on you just a little bit there and I could be wrong. I, I, I certainly am plenty of the time when I think of a best practice in healthcare. I'm thinking of a common denominator. I'll elaborate James within that. There has to be a lot of customization. So the concept is mass customization, right? I mean, there's, there may be a, a set of parameters within which one works to customize. Does that make for sure.
Speaker 2 00:52:02 And I definitely think that there are kind of guideposts or directional things. And so I'm still playing with the nomenclature, whether, you know, what, what the alternative is, but the working concept is this idea of informed practices. All the say right, is there's a base set of principles, but what are the unique circumstances that define what decision you kind of make and really having conversations in the industry of, okay, so what I need to do, you know, we're sitting here in Nashville. What I need to do for my patients in Nashville is going to look a lot different than what I do for my patients in Atlanta. And here are the things why it's not just geography. It could be, you know, the leadership, it could be the facilities in the area. There's so many different factors that, right?
Speaker 0 00:52:45 So, so, so let me give you an analogy in the practice of medicine. And I want to hear how you think about this. So on the one hand, you've got pure creativity, right? I am the doctor and I've read all this stuff. Maybe I don't remember it all, but I know how I was trained and what my partners do. And, and I'm going to craft for you out of nothing, this beautiful way to take care of your diabetes. On the other side of that equation is no look, that's, that's the craft of medicine. And we do know something about the delivery of medicine down. Furthermore, you know, that was back when the PDR was maybe a quarter of an inch thick and you could keep all the drugs in your head and all the protocols, your head that is the craft of medicine. We need knowledge management now.
Speaker 0 00:53:29 And the reason there have to be informed practices, I'll use your term is because nobody can keep all of that knowledge in their head anymore. There have to be some basics in the physician's job has gone from remembering everything that I have to do. And when I have to do it to, yeah, I've got this protocol, but I'd better pay attention because everybody's different and this isn't going to fit them. This is also a bridge James concept that I'm stealing shamelessly. Where do you sit on that continuum? And I'm still trying to understand your notion of, I don't like best practices. Yeah.
Speaker 2 00:54:02 I think it's a good push because I think the clinical context is probably a little bit different from the kind of organizational context. But, but let me, let me reframe maybe back to kind of the data and the trends. A lot of what I, I think that the problem is, is we tend to make assumptions based off trends that we think apply to a hundred percent of the pie. And so there are certain things that only are common for 10 or 15% of the population, because we don't quite understand those factors that influence those trends. It's human nature to assume, oh, well, then that must be true of the whole populations. So I'll give you an example. You know, we just worked on a study looking at, you know, tele-health trends because everybody wants to see post COVID. What is that look like? And yes, like we all know tele-health, we've seen rapid adoption.
Speaker 2 00:54:49 There's a lot of things about it. And there's so many people who've written on it, but that has primed us all to say, okay, the best practices, you know, telehealth is going to be good for these cases. And it works here. Okay. But, but let's dial it back. Let's look at, okay. Does that trend apply to all patients segments? And when I say patient segments, it's not just Medicare versus Medicaid versus commercial it's. How does it trend differently within Medicare women versus Medicare men? How does it trend differently between commercially insured women ages 30 to 39 versus 50 to 15? And so when you start pulling back the layers and dissecting how these trends apply to different, um, I'm using the example of net population segments, but it could be organizations, it could be market, whatever it may be, zip code, then you start seeing a very different picture. And so my point around best practices is if you start unpacking those layers, is there a best practice for, for tele-health for, you know, across the board? Probably not. But I think there is an informed practice for the Medicare age. You know, I have to articulate that a little bit better, but that's kind of the working kind of
Speaker 0 00:56:01 Concept. Oh, and what you're saying, I think what I hear you saying is that there are two kinds of errors, right? And to go back to the, uh, medicine analogy, the error that this doctor is going to make over here, where he's crafting medicine for you, she's going to forget stuff. There's stuff. He's not going to know. He's going to make that kind of error. This guy over here, where he's got some structure around it, it's like here, you know, here are the targets you want to hit in terms of the outcomes. Here are the, uh, the usual medications that one puts on first, second, third year he's going to make is thinking that all he has to do is sign that and it's ready for prime time. And that is equally as dangerous and error as the first one. Your exposure is almost exclusively to that kind of error. Whereas mine, uh, you know, started probably in a very different place with the, the error of the craftsmen, if you will. So it, I think we're coming to the same place, but from different perspective. So I think I follow you. Yeah.
Speaker 2 00:56:59 Yeah. And you know, the last example, baby, you know, we think a lot about health systems, right? So we were talking about this earlier. So, you know, inner mountain and Geisinger's experiences as health systems and they're leading organizations, they've done a lot of great work in population, health management, and, you know, it can make a whole list there also their lessons learned and their best practices may not actually work in the Phoenix market. Right. Because for so many reasons, but we don't, we're not trained really as an industry or it's not normalized as an industry to say, okay, well, what are the factors that vary between inner mountain in banner? There are definitely similarities, but I would argue that there's a lot more differences, but the foundational principles of population health strategies, you know, are there for everyone, but they have to be tweaked.
Speaker 0 00:57:47 Got it. Okay. That makes a lot of sense. All right. So, so we, I took you way off track again. So where are we? We are at, uh, Johns Hopkins. We've been teaching, we've cut back on our teaching. We're writing a blog called the compass
Speaker 2 00:57:59 In them. What? Yes. So, you know, through all these conversations, all these thinking, I'm getting ready to start writing this blog and get a call from, or was introduced. I should say to the CEO of this company called Trillium health based in Nashville company that I had never heard of. And it's a data data and predictive analytics company that really brings together claims data, consumer data, population, data, just all the data sets you can think of in some ways, healthcare and non-healthcare and really puts together a individual patient view. And that includes demographic, demographics, and behavioral. I mean, there's a whole host of data sets, you know, the best analogy that I think about you, I think about Amazon or political campaigns. I mean, all these consumer brands have so much information on individual consumer preferences and how they behave. And we talk a lot about consumerism and healthcare, but we don't actually have the data to do that.
Speaker 2 00:58:52 And so trillion has all the data and they use machine learning and all of these tools and methodologies to stitch all these pieces together so that you can have that consumer view. I started learning about trillion, you know, through this conversation with our CEO. And I said, well, that's too good to be true. Like, you know, we talk about these things, but you're actually building that and started learning more about it and realized that a lot of what I was trying to do in terms of guiding the industry of where are the trends headed, you know, ultimately I didn't all the data that I would love to have to be able to do that. How do we really use data and predictive analytics on top of the data to make better decisions that are contextualized for specific scenarios, whether that's market or behavioral profile of a specific consumer segment
Speaker 0 00:59:38 Summarize that as data Disney world for Dr. Jane. Yeah.
Speaker 2 00:59:43 I love that. It's true. It really was. I remember getting on the phone with Howard the C and I said, okay, like, it's just, that sounds way too good to be true. I mean, you're like, there's no way that all of that exists. Right. That's the dream. And, um, you know, I, I didn't believe it until I saw it and put all the pieces together. And basically to your point, it's this treasure trove of unlimited data that I have to write these data stories and go look through it and see, you know, what are the trends? What are the patterns? What are the things that we're not thinking about that maybe becoming trends that we need to prepare for that are going to come impact us 10 years from now,
Speaker 0 01:00:18 I'm going to start asking you some, uh, some specifics around, uh, data in trends, because I know everybody is, is going to be curious by this point. What do you think are the principle trends, post pandemic, that health systems, payers, patients, anybody should be aware of
Speaker 2 01:00:35 Carson. We can be here for five hours. Um, let me take that one step back for a second. I think it's probably less about the trends, but it's this idea of how do we think about all the noise and different things happening? And so the framework that I like to think about all the trends and the ecosystem being a health economist, I guess I'm a little bit biased here, but this idea of supply demand and yield. And so when I, when I say that, what I mean is, okay, so the suppliers who are all the people who provide a care service, whether that's the hospitals, health systems, position groups at today, that means Walmart and telehealth providers, right? The, a lot of them overlap. So there's a broader set of suppliers in healthcare. And so there was a series of trends that existed in that domain, which we'll come back to then I think about demand.
Speaker 2 01:01:19 So who are the consumers that actually are creating the demand for those services? And I think there's a, there's a broad definition there, but it's from anything from your actual clinical need for service, you know, chronic conditions to your actual preferences as an individual. Do you like to see your physician virtually, or do you like to go in person and you know, how often do you like to see the doctor and do you like to exercise? Like there's a whole host of preferences that we have that dictate how we want to receive care when and how frequently? So that's kind of on the demand side. And then ultimately it's the intersection of those two that create yield, which really is kind of the cost of care and how expensive is care and where we allocate our resources. And as you know, consumer, if I'm making, you know, decisions of where I want to go, and of course there was a policy layer on top of that in terms of how incentive schemes affect, you know, how much we pay for things, all the say, when you look at all the trends and all those areas, you know, there's a lot within that.
Speaker 2 01:02:16 And what I've found in some work that we're doing right now is at the end of the day, post pandemic, we have more supply than there is demand. And because of that, that is creating this unsustainable yield in effect, unsustainable kind of high prices that are artificially inflated. So what do I mean by that? I means that we're seeing so many people enter the healthcare market in a variety of different areas, right? Behavioral, health, telehealth, you know, post-acute care, whatever it is,
Speaker 0 01:02:45 Walgreens I, or a Walmart, uh, 98.6, a Teladoc, right. In addition to traditional, uh, services.
Speaker 2 01:02:55 Yeah. And the traditional hospitals and our communities where we, as we saw in COVID, I mean, at the end of the day, it was the hospitals and the health systems that were treating that patient population. Right.
Speaker 0 01:03:05 So you have all these suppliers
Speaker 2 01:03:08 Based off the assumption that there's going to be, this ever-growing increase in demand, and we could spend a whole hour to kind of defining the demand, but I'll pick on tele-health again, because that's an easy analogy, but you know, everyone's saying that tele-health, you know, the demand for tele-health is so large, but no one has actually quantified that. Well, we just did, but you know, it's, but up until now, there has been no number thrown out of, okay, like who is asking for it, who is using it, how much demand is there. And so without that information, we've seen a lot of supply that was in the market. Well, before the pandemic, a lot that kind of emerged during and we're going to continue to see. And so that's where this mismatch is kind of happening. And so interesting. That would be, I mean, there's, there's lots of unpack within that, but I think when you think about the post pandemic economy, health economy really is this uneven, there's this mismatch. And ultimately that mismatch is what's creating this mismatch of resource allocation and why, you know, certain areas see things differently. Yeah.
Speaker 0 01:04:07 Yeah. That's interesting. So one of the purposes of this podcast is to get a variety of different perspectives on how to fix healthcare. Now you could argue that there's nothing to fix because as we talked about earlier, it's functioning exactly the way it's designed. You know, there's, there is no mistake here. People are following the incentives and, uh, and maybe that's a clue, I don't know. But, but in your view, what do you see as the fundamental steps to move us towards what has been simplistically called the quadruple aim, right. It's better quality, a better experience for the consumer in some cases, the patient, in some cases, not somebody seeking information, lower costs, for sure. I mean, we're all sort of reeling from healthcare costs and still the number one cause of, uh, private bankruptcy in this country, which is unconscionable, uh, Johns Hopkins, uh, docs have been at the forefront of documenting a lot of these abuses and ended a better experience for the docs too, because we know burnout's a problem. So what are the fundamental steps? What would you say if somebody came to you and said, Dr. Jane, you've been looking at all this stuff, you, you, in with a fresh perspective, a new perspective, you've got tons of data. What do we need to do as a society? And a huge question, you know, but I figured that we can have this problem solved B for the hour,
Speaker 2 01:05:32 About a month for the challenge. No, I mean, I think it comes down to corporate symbols and th there are two major gaps that I think, you know, are limiting our progress in the industry. Think one is this idea of silos. You know, it's amazing to me that I have conversations, you know, with, on the hill and any kind of the policy sphere, how little they know about the realities of health systems and, you know, the impact that they have in their communities, or how many individuals they actually employ and reconcile that with, you know, what are their priorities and what's happening on the pharma side and the payer side. And so we had these historical silos. And so we're all working for the same cause, but yet we're not aligned kind of on the same, on the same team. And there's a lack of awareness of these different players and how they come together, which, you know, basically leads to kind of mismatch, incentive schemes, right.
Speaker 2 01:06:20 And so you've got pharma doing one thing and you've got providers doing one thing. And so, you know, conceptually, we have to figure out how to start seeing more of that alignment and intersections, you know, between that. And that's not just the player, you know, the suppliers, it's the policymakers, it's it's consumer groups. It's non-health yeah. There's a lot of people that have to come to the table. That's one piece of it, but underlying all of that is the right information to act on it. So, you know, I'll pick on the policymakers, whether it's CMS coming out with new payment models, there's a lot of data and research that's being done on the success of those programs, but to make decisions within the confines of our kind of current incentive system, the way that's meant to design. I don't think that every player has all the information that they need kind of across the silos. If we all kind of broadened the problem set and really try to understand what was happening with our other healthcare kind of partners beyond just kind of the lanes in which we think about and could actually quantify that and measure that, I think we would all have a better FactSet to then start making decisions that can get us to the triple aim or quadruple aim. Sorry. Yeah,
Speaker 0 01:07:26 Yeah, yeah. You know, I, there are so many things that are coming to mind, we'll have to do probably a whole nother show to unpack all of them. One is, uh, incentives, uh, you know, big piece of the pie government is responsible for over half of all healthcare payments now. And the government is still mostly in the fee for service mode and that drives certain behaviors in over-treatment. The other thing that came to mind as you were speaking, is some of these silos are by design, right? The some for good reason, some not, but the end of fact, you're right, is that you can only see so far before you come to a silo wall and you can go around the corner, but now you can't see behind you anymore. You can only see what's in that silo and so on and so forth. And then the other is around and maybe both of those contribute to the problem of price opacity, for lack of a better term, the being transparency, right?
Speaker 0 01:08:16 It's not a market essentially. So how does data help us move to better incentives to serve the issues that we have today and towards more of a market, which we know when real markets exists. And I'm not saying that unbridled capitalism is the solution either. Obviously we've learned that there has to be some level of oversight, usually that has to be by a government body of some kind, but how does data help us get to that place where we have more transparency, more interoperability, and closer to a real capital market than what exists in healthcare today?
Speaker 2 01:08:53 I think ultimately the consumers are, have started to drive that change, right? So healthcare, to your point, if you look at any other kind of regulated consumer industry, I was traveling earlier this week. So I'll pick on airlines and Uber. We know that prices for a flight or an Uber ride are going to vary based off of time of day, how many drivers are out there, the demand, right? Like it comes back to supply demand and yield. And, you know, they're, they're, they're operating within the confines of economic principles and they use data to do that. So, you know, airlines can adjust their prices based off real time data on how supply and demand is changing instantaneously and how it's changing and, you know, certain markets, same thing with Uber, same thing with any consumer good like Amazon and Walmart, right? There's a lot of industries that are ultimately serving the consumer that, that use those levers to drive price and it's supply and demand, but healthcare hasn't done that.
Speaker 2 01:09:48 And that's where data comes into play because our industry is no longer the traditional healthcare industry, because you have historically what I'll call consumer companies like Amazon and Walmart coming in. And so they're operating by these principles of economics, right? Third thinking about supply and demand. I mean, Uber and Lyft are now in healthcare too, right? And so you have all these new players that are used to operating businesses with the consumer at the center, thinking about supply demand and yield, and by the way, using a ton of data to help them understand those, those forces and how they're changing, you know, by the hour, by the day, right in real time. And then traditional healthcare is on the other end of the continuum that not only are they not thinking about supply demand and yield, but then they don't have the data to begin to understand the real magnitude of it and how it's changing.
Speaker 2 01:10:40 You know, even as a researcher, I'll, I'll pick on this, an academic research where right, by the time you write it, publish a paper, you know, it's using data from two years old, right. And so things change so fast, but yet our decision-making trajectory and our ability to make decisions doesn't match that pace. And so to answer your question, I mean, I think data is really this, this bridge that can help us have visibility into the fuller picture and then use those levers to then ultimately, you know, bring costs down and figure out, you know, where the needs are. And ultimately it's all about the consumer.
Speaker 0 01:11:12 That is a great answer. And so if I can, if I can, uh, summarize what Trillian does to make sure that I understand that trillion is an aggregator of data from many, many disparate sources that are all about the consumer and that consumer's behavior in the context of the healthcare market. And it's not just that, but it also has a machine learning that is crunching this data constantly to try and come up with trends and understand trends. Not that are necessarily if there's a prediction it's that they will continue, I guess, because it's really talking about what's happening, is that accurate in,
Speaker 2 01:11:53 I think the missing piece. So what you just said is this idea of the predictive piece. So historically in our industry, we've used historical data to make decisions about the future. What a lot of our tools that truly allow us to do is taking all these data, but then forecasting it based up all the assumptions of the trends happening. So given the fact that during COVID a lot of people move to different cities, given the fact that we all have different behavioral profiles, right? Thinking about how we make decisions, given the fact that we have all this scientific innovation and drug therapies that are changing the prevalence of disease and how we treat people. There's so many factors that influence the future. And so using these models with not only the historical data, but then are contextualized with where the trends are headed. It actually can fo we can forecast, you know, scenarios and the likelihood of that at the market level. And so, you know, what does the demand for digestive surgeries look like, which might be different than the demand for, you know, orthopedic surgeries, what are the levers and factors that influence, you know, those shifts, why is it going up where is going down so that organizations can prepare for that reality and make decisions accordingly.
Speaker 0 01:13:05 So in its simplest iteration, it is designed to inform leadership of healthcare organizations about what to expect in terms of supply demand and the consequences of that, so that they can make smarter decisions about the allocation of resources to basically improve their efficiency and take strategy out of the realm of opinion into the realm of data driven strategy. Is that accurate?
Speaker 2 01:13:36 Goodness, I better myself.
Speaker 0 01:13:38 I think that's probably a good place for us to wrap up because I don't want to exhaust you because I want you to come back. But my final question is this the future of healthcare, not just in the U S but in the world, you have a pessimist or an optimist.
Speaker 2 01:13:52 I'm an optimist because you know, there's so much innovation. There's so much convergence happening in different ways. I mean, it's all there. We just have to figure out how to bring the pieces together and make sense of it. There's all the answers are out there. We just have to stitch them together.
Speaker 0 01:14:08 That is a fabulous place for us to wrap up. But with one more prediction this time for me and my prediction is that Dr. San Angelo Jane will be a big part of that to going forward. So thank you so much for, for being on the show. And I hope you'll agree to come back because I have so many more questions. I learned so much in this session. I've got a process that a little bit before I come back with more. Thank you, Dr. Gross. This is really fun. All right, bye. Bye.
Speaker 3 01:14:38 You've been listening to the groves connection, your connection to the inside story on healthcare. Featuring in-depth interviews with those who know you can find us on apple podcast, Spotify, and anywhere else, you get your podcasts. If you like what you hear, give us a five-star review to keep the connection going and hit the subscribe button to be sure you never miss a beat. The groves connection is produced by Dr. Robert groves, original music editing and creative direction provided by Alden groves, production, support, content guidance, courtesy of Janae sharp and Elizabeth Barrett. Thank you for listening.
Speaker 0 01:15:23 The professional ideas and opinions expressed in this podcast are mined and do not reflect those of any current or past employers. Thank you so much for listening and we hope you'll join us next time on the groves connect.
