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Crash Course in Health System Quality Improvement with Dr. Neha Patel

– Logan Brock, MS2 –

For our most recent HealthX Crash Course, we hosted Dr. Neha Patel, MD, MS, who gave a Crash Course on healthcare quality and patient safety. Dr. Patel earned her medical degree at the University of Pennsylvania School of Medicine and completed her residency in internal medicine at the Hospital of the University of Pennsylvania. She has been a practicing hospitalist in the Section of Hospital Medicine since 2009. During her time as faculty at Penn, she completed a Master of Science in Healthcare Quality and Patient Safety at Northwestern University in 2013. In 2016, she transitioned from Interim Chief of the Hospitalist group to become Associate CMIO at Penn, in a role that was specifically created for her to develop Penn’s mHealth strategy. Additionally, she serves as the Director of the Healthcare Leadership in Quality Residency Track, which prepares physicians for leadership roles in health system by providing hands on experience improving healthcare quality. To top it off, she serves as Director of Mobile Strategy and Applications at Penn Medicine. Here are some key takeaways from her talk:

Work Within a Framework – It Doesn’t Matter Which

The key to successfully implementing quality improvement projects in a hospital system is to use a framework that allows problems to be approach systematically. While this is crucial to ensure effective quality programs, it is less important which specific framework is followed. There are a number of different change management systems that are used in healthcare, including Six Sigma and the Model for Improvement. While these models differ slightly in their approach, each provides a method to rapidly design, test, improve, and implement changes to hospital systems, allowing the hospital to continually improve.

Measuring Healthcare Quality is Extremely Complicated

While it certainly isn’t surprising to hear that measuring quality in healthcare can be a challenge, Dr. Patel illuminated just how challenging it really is. In the current healthcare climate, terms like “bundled payments” and “value-based purchasing” are frequently tossed around – however, it can be rather complicated to understand what they really mean. As an example, Dr. Patel brought the current year’s value-based purchasing “domain weighting” chart – essentially, the metrics to which 2% of all Medicare payments are tied in 2018 (here’s an overview of value-based purchasing). The metrics include four categories that contribute to the overall “value” the hospital provides and multiple subcategories within each category. As an example, one sub-category is “pain management,” as reported by patients. The score used for this metric is compiled from surveys randomly given to patients, in which they rate the quality of their hospital stay. Thus, improving the score would likely require massive overhauls in hospital operations, and this is just one of many metrics to which hospital reimbursement is tied. This crash course conveyed the immense challenge of measuring healthcare quality.

Improvement Requires Openness to Evaluation

Dr. Patel highlighted one of the most significant challenges to implementing quality improvement initiatives in the hospital – in order to make changes to improve a process, it is first necessary to admit that the process might be flawed. In a healthcare system where doctors are working as hard as they possibly can to provide the best care they can, it is a difficult shift to admit that there could be room for improvement. Thus, one of the key challenges in improving healthcare quality is allowing the measurement and reporting of areas where care could be enhanced. This is naturally difficult for a profession in which mistakes can have life-or-death consequences, but it is crucial for continual improvement.

 

It was a pleasure to host Dr. Patel and learn more about quality improvement in healthcare and the significant challenges that physician-leaders grapple with every day in their quest to provide better healthcare.

– Logan is a second-year medical student at the Perelman School of Medicine. He is the co-VP of curriculum for Penn Health-X, an occasional co-host of the Penn HealthX podcast, and a contributor to the Penn HealthX blog. You can contact him at  john.brock@uphs.upenn.edu –

Crash Course on Medical Device Start-Ups with Dr. Jeffrey Solomon

jeffreysolomon

– Logan Brock, MS2 –

For our first HealthX Crash Course, we hosted Dr. Jeff Solomon, MD, MBA who gave a Crash Course on the medical device industry. Dr. Solomon earned his medical degree at the University of Pennsylvania School of Medicine, completed a residency in diagnostic radiology and a fellowship in interventional radiology at Penn, then stayed on as an attending in the IR department. During his fellowship, he also earned an MBA at the Wharton School at the University of Pennsylvania. After working as an attending for several years, Dr. Solomon chose to leave clinical practice to become President of Infiniti Medical, a medical device company focused on the veterinary market. With this perspective, Dr. Solomon shared some lessons he wished he knew when he made the transition to the startup world. Here are some key takeaways from the talk:

The One Constant in Startups is Risk

We constantly hear about the excitement and the fast pace of startups, but Dr. Solomon focused the crash course on what he believes is an equally pervasive aspect of life at a startup: risk. Throughout his talk, Dr. Solomon reminded us that while we hear stories of the startups that succeed, there are many more companies we never hear about because they failed. Rather than trying to discourage us from pursuing a startup career, he encouraged the audience to inform themselves of the risks and to consider them carefully when weighing the decision whether to pursue a startup career. He emphasized the importance of balancing the risk and the potential rewards and only pursuing an option when the rewards outweighed the risks by enough to justify the risk.

Startups Must Succeed or Fail Quickly

Dr. Solomon explained that building and operating a private company is not an option for a startup that has taken on venture funding. While this might seem like a possible route, venture funds have defined periods of time after which they must return capital to the limited partners. As a result, a venture fund is forced to pursue an exit at that point. Therefore, companies must always operate with the goal of a liquidity event – an IPO, a strategic acquisition, acquisition by a PE firm, or failure. From the founder’s perspective, this actually has a benefit – Dr. Solomon stressed that failing (or, of course, succeeding) quickly is better than failing over many years.

Understand Equity Dilution

With very rare exceptions, startups cannot succeed without raising capital. Thus, founders must partner with sources of capital to make their ideas into realities. Dr. Solomon spoke at length about the different types of capital available to entrepreneurs and the associated benefits and drawbacks. These sources include personal funds, friends and family, angel investors, and venture capital (which are usually received in that order). As a rule, as a founder moves from personal funds toward venture capital, each subsequent investment requires dilution of equity and loss of control over the company.

It is crucial for the founder of a company to understand how taking on funding affects both company control and the distribution of equity. Dr. Solomon illustrated how dividends, liquidation preference, stock options, creation of new stock classes, and the fees associated with selling a company could substantially decrease the founder’s share of an exit. From the outset, an entrepreneur should take careful stock of the amount of funding they will need to raise to bring the company to an exit and ensure that there will be a sufficient stake remaining after that dilution to justify the risks of starting a company.

It’s Easier to Ask for $100 Million than $1 Million

Building a company is a huge challenge, whatever the market. Since it’s going to be difficult either way, pick a market that is worth working long and hard to capture. This benefits the company in multiple ways. First and foremost, if the company succeeds in a large market, that success will be all the more significant and exciting than if it occurred in a smaller market. Beyond that, Dr. Solomon stressed that it is significantly easier to raise capital to go after a big idea than a small one. Venture firms make multiple investments and expect that some will fail – therefore, they have a strong incentive to place large bets that can lead to significant gains. A venture fund will often not be interested in a company with a $10 million market – even if the company succeeds, that success wouldn’t move the needle for the fund. A startup that targets a $1 billion market, on the other hand, could provide exactly the success the venture firm needs.

 

It was a privilege to host Dr. Solomon for our first HealthX Crash Course, we learned a great deal about the medical device startup world, the risks involved, and what it takes to succeed.

– Logan is a second-year medical student at the Perelman School of Medicine. He is the co-VP of curriculum for Penn Health-X, an occasional co-host of the Penn HealthX podcast, and a contributor to the Penn HealthX blog. You can contact him at  john.brock@uphs.upenn.edu –

Spectrum Scores, LGBTQ+ Health Disparities, and HealthX Labs (Episode #11)

 Ryan O’Keefe, MS2 –

In the most recent episode of The Penn HealthX Podcast, I was able to sit down with Phil Williams, Naveen Jain, and Jun Jeon, the three co-founders of Spectrum Scores. Spectrum Scores looks to address health disparities in the LGBTQ+ population by connecting patients with providers who are able to address any unique healthcare needs they have. The project was launched out of the 2017 HealthX Labs accelerator program, and has continued to grow since.

Some takeaways from our conversation:

1. If you don’t care about the problem, you will quit

The team repeatedly mentioned the importance of identifying a problem, rather than trying to force a solution you’ve come up with down people’s throats. This is important advice to remember when starting a company – the idea needs to be born out of an identifiable need. Otherwise, when push comes to shove, no one will use your product. More importantly, if you aren’t drawn to the problem you are looking to solve, in all likelihood, you will lose motivation, and give up. You may be able to push through for a while, but if your heart isn’t in it, you won’t last.

2. If your idea is truly innovative, most people won’t understand it

History tells us that inventors and innovators who are well ahead of their time are met with severe skepticism, and even ridicule. Not everyone will have the same vision as you, which can be rather troublesome in the modern world, considering meaningful innovation in healthcare often requires substantial investment and buy-in from larger players in the system. In the case of Spectrum Scores, it wasn’t that people didn’t understand the idea. Rather, many who are not members of the LGBTQ+ community simply can’t appreciate how crucial the problem is. Further, the same people won’t understand that tight-night communities are able to help a project like Spectrum Scores gain traction. The usual concerns companies need to address when pitching their ideas – what is the market, how will you make money, how soon can you exit and see a meaningful return on investment – are simply not the main focus of Spectrum Scores, at least for now. Those who want to work at the intersection of advocacy, medicine, and business will likely deal with these very objections. It doesn’t mean your idea is unattainable, but it does mean you face a steeper incline.

3. If you worry too much about perfection, you’ll wind up with nothing

I appreciated when the team shared their initial discomfort with releasing their product to the masses. Many in medicine are Type-A personalities, who want to do things right and have their work be flawless. However, if you spend all of your time fussing about how your product is imperfect and not ready to be judged, you will wind up with nothing. Being vulnerable is part of the process – feedback from others is what drives improvements in your products, and will bring up things you never even thought about. Compromise can be difficult, but if you put yourself out there, and have a truly innovative and meaningful idea, the details will work themselves out over time.

4. Publicity can build on itself, so be ready!

Though you may have to sacrifice perfection when starting a company, you do need to have a polished, presentable pitch ready to go. As the team shared, you never know when NBC will want to interview you. Publicity in the modern age can be confusing and surprising, but if you are lucky, it will build on itself, and others will begin to take notice of your company. This can be nerve-wracking, but it also keeps you on your toes, ensuring you are putting out the best product you can. Nothing lights a fire under you as much as built up expectations and hype. You may not always be able to control your messaging, but you can do your very best to deliver what you promise.

– Ryan is a second year medical student at the Perelman School of Medicine. He is the co-VP of curriculum for Penn HealthX, the co-host of the Penn HealthX podcast, and founder/editor-in-chief of the Penn HealthX blog. You can contact him at ryan.o’keefe@uphs.upenn.edu –

BA Sillah on Investing in Africa – (Podcast #9)

Logan Brock, MS2

On the most recent episode of the Penn HealthX podcast, we had the opportunity to speak with BA Sillah, an MD/MBA student who recently graduated from Wharton and the Perelman School of Medicine.

BA has a BA in Human Developmental and Regenerative Biology from Harvard. He researched bio-fabrication while at Harvard, then came directly to medical school after graduation. While at Penn, he worked as a Hospital Management Intern with the King’s Sierra Leone Partnership, an Operational and Investment Fellow at the Excelsior Group, where he evaluated venture investments on the African continent, and as an intern in the Specialty Pharmacy Department at Penn Medicine.

Some takeaways from our discussion:

1. Healthcare on the African continent varies widely by country

BA highlighted for us the disparities in healthcare between different nations in Africa, as each country uses a different strategy to guide the structure of its healthcare system. Some countries (Egypt, Tunisia, South Africa) have healthcare systems rivaling that of the United States, while others have fledgling systems that are still in early stages of development. As a result, the continent provides a myriad of examples of the various ways to set up a healthcare system, which will provide interesting insights about what types of healthcare systems can and cannot work effectively.

Another interesting challenge for healthcare in Africa is the changing socioeconomic landscape of the continent as countries develop and a growing middle class emerges. In the face of this change, healthcare systems are forced to decide whether to tailor their systems to serve the emerging middle class, who can generally afford to pay some of the cost of their healthcare, or whether to focus on providing care at low/no cost to the poorest citizens. As one example, Ghana provides National Health Insurance that covers all of its citizens – however, a private insurance market exists for the middle class who want to pay more for additional benefits not provided by the national plan.

2. Economically viable companies are more sustainable than charity care

Currently, charity care makes up an appreciable proportion of the medical care available on the African continent, particularly in less-developed nations. While charity care is provided with good intentions, it has unintended consequences. The provision of care by volunteers who only stay for a couple weeks leads to serious gaps in the continuity of care and a lack of long-term follow-up. Additionally, the myriad organizations that travel to provide charity care often do not share records – thus, it might be challenging or impossible for a patient to locate their own medical records. Conversely, investments in economically viable enterprises allows for the development of more sustainable healthcare delivery. If a company is of sufficient quality to attract venture investment and can provide a return on the invested capital, it indicates that the business model is sustainable. Instead of relying on providers to continue to donate time and money, these organizations will continue to exist for as long as they continue to generate a profit. Thus, venture investments in healthcare in the African continent help to ensure that a healthcare ecosystem develops that can sustain itself, instead of relying on transient volunteer care.

3. Investing in Africa requires wearing many hats

During BA’s internship at Excelsior, he saw firsthand the challenges facing healthcare companies on the African continent. As an example, he spoke with us about his work on a pharmacy company that was looking to expand into another African nation. He found that the initiative was fraught with challenges ranging from a complicated supply chain to a plethora of counterfeit medicine. He had to look beyond the company itself and work for increased regulation of pharmaceutical manufacturing to ensure the authenticity of medicines. In another project, he found that to help a diagnostic company succeed, they had to go beyond marketing and go directly to hospitals and medical schools to educate physicians on the use of ultrasound. As a result, the work BA performed to ensure the success of investments had positive benefits on the entire healthcare system.

We really enjoyed sitting down with BA to hear about his experience learning about and investing in the healthcare industry on the African continent. He showed us the ways that venture investments could lead to an independent and self-sustaining healthcare system and create unexpected positive benefits for the healthcare system. We’re excited to see what he does next!

– Logan is a second-year medical student at the Perelman School of Medicine. He is the co-VP of curriculum for Penn Health-X, an occasional co-host of the Penn HealthX podcast, and a contributor to the Penn HealthX blog. You can contact him at  john.brock@uphs.upenn.edu –

Eric Heil on Co-Founding RightCare Solutions, Studying Systems Engineering, and Reducing Readmissions (Podcast #8)

Ryan O’Keefe, MS2 –

On the most recent episode of the Penn HealthX podcast, I had the opportunity to speak with Eric Heil, who co-founded RightCare Solutions, a health-tech company that helped hospitals reduce readmissions rates and optimize post-acute care delivery. The company was acquired by Navi Health in 2015.

Kathy Knowles, a rock star at the Nursing School at Penn, was the other co-founder.

Eric has a BSE in Systems Engineering from Penn, and an MBA from the Wharton School as well. He played basketball at Penn, and even made it to the NCAA tournament twice in his career. After graduating, he took on numerous different jobs working at the intersection of business and healthcare which ultimately prepared him to found his own company.

Some takeaways from the discussion:

1. You don’t have to have a master plan – conviction will drive you in the right direction

Eric admitted that though he had an interest in making systems better, and the healthcare space more generally, he didn’t have a “master plan” for his career and life. In fact, he tended to go with his gut whenever he learned about something new and exciting that he could get involved with. For example, when he learned about the opportunities in venture capital, helping to advise companies and bring their products to market, he went to Domain Associates. When he discovered that his old thesis research at Penn was suddenly valuable because of new ACA regulations, he immediately contacted Kathy Knowles to see if she wanted to partner up and found RightCare.

Eric mentioned that when it comes to making changes in your line of work, the book Letters to a Young Entrepreneur by Ricardo B Levy helped him understand that you will feel a sense of “conviction” that guides you to new projects. Furthermore, sometimes you will just need to get lucky. Eric left Bear Stearns four weeks before the financial collapse in 2007 and 2008. Many (including his father) told him he was nuts to leave such a promising job, and yet he knew it was the right thing for him. Sometimes going with your gut can prove to be fortuitous – if Eric had planned on staying at Bear Stearns forever, he would have been hit with a large dose of reality. Remember not to stick too closely to a “master plan”.

2. Go to conferences and talk to people about your work and ideas

While listening to Eric’s story of founding RightCare, the thing that struck me most was the setting in which some of the initiating conversations happened. It was at the JP Morgan Healthcare Conference in 2011.  This really hit home for me just how important going to conferences to talk with other like-minded people thinking about the same types of problems you are. It was here that Eric learned about how he was essentially sitting on a goldmine of data because of the new ACA regulations.

It’s not only important to physically surround yourself with people working on exciting projects in your fields, but to also engage them and not be afraid to tell them what you do, and what you want. One thing I’m personally working on is how to properly promote myself. It’s often an uncomfortable thing, but it’s so crucial to let everyone know what it is that you want. You never know who is out there who has the connections or knowledge to help you out.

For those at Penn or in the local Philadelphia area, check out the annual Wharton Business in Healthcare Conference, and Penn HealthX Conference to meet students, faculty, and KOL’s working at the intersection of business and medicine.

Here are some interesting resources I found on how to market yourself at conferences:

http://www.apa.org/gradpsych/2014/04/market.aspx

http://blogs.plos.org/paleocomm/2015/12/03/networking-how-to-market-yourself-at-conferences/

3. Things Move Slowly in Healthcare – Change is Hard

 Entrepreneurs love sayings like “disrupt” and “fail forward”. While this often works in many tech fields, unfortunately things can be way more difficult in healthcare. Change is always harder than everyone expects. One reason for this is that when dealing with people’s healthcare and lives, you can’t afford to experiment and get things wrong. There is a strict process we must follow to ensure that all patients receive the highest quality of care, and any change to the way care is delivered undergoes intense scrutiny from many parties. Just think about the FDA, and how difficult it is to get drugs and medical devices approved. The same goes for healthcare technologies entrepreneurs are looking to implement in hospitals, like RightCare.

It’s important to recognize the difference between inertia that is properly built into the system to protect patients, and that which is there because of the status quo. Go through the proper channels, but don’t take no for an answer, or let one party out of the many you work with dictate everything you do, simply because you are afraid to speak up and push the process along. People skills will be very handy when dealing with such barriers.

4. It doesn’t have to be your idea

My favorite part of the RightCare story is that it wasn’t technically Eric’s idea. He got involved with his thesis at Penn after hearing about the opportunity from a professor. The data that was collected over the years which gave the company its value was mostly consolidated when Eric was off working at other jobs building other meaningful skills. Yet, because Eric felt conviction, saw the opportunities, and pulled the trigger, he was able to serve as the co-founder and CEO. It doesn’t have to be your idea! But if you have a skill-set to help drive the mission of the company forward, offer your time and brain – your two most valuable assets. Pay attention to the amazing opportunities all around you, and figure out how you can best contribute. You may stumble upon one of the greatest opportunities of your lifetime. Be prepared and speak up.

 

– Ryan is a second year medical student at the Perelman School of Medicine. He is the co-VP of curriculum for Penn HealthX, the co-host of the Penn HealthX podcast, and founder/editor-in-chief of the Penn HealthX blog. You can contact him at ryan.o’keefe@uphs.upenn.edu –

Tim Carlon and Value Based Payments (Podcast #7)

Logan Brock, MS2

We had the chance to sit down with Tim Carlon, an MD/MBA student a few years ahead of us in medical school at Perelman. We got to speak about his passion, value-based payments. Tim taught Ryan and I about two models of value-based payments that are currently being piloted, accountable care organizations and bundled payments. He also told us about MACRA – a law that neither of us knew much (if anything) about before this conversation, which has huge implications for future physicians and how we will be paid.

Tim graduated from Duke University with a degree in biomedical engineering. While he originally thought he would pursue a Ph.D., Tim chose to go to medical school so he could see the effects that his work had on patients more directly. During his time in medical school, Tim discovered a passion for making the healthcare system function more efficiently, and he viewed value-based payments as the best way to do this. Tim spent this summer at Cigna, where he worked on value-based reimbursement.

Some major takeaways from our conversation:

1.) Value-based payment models will allow us to (finally) align the incentives of doctors and patients

While many people believe doctors are paid for providing quality care, this has only recently become the norm. Until the last decade or two, not only were payments not tied to quality, but lower quality care could actually benefit a hospital financially. For example, if a patient had a complication following a procedure, the hospital could profit from both the initial episode of care and from the readmission to deal with the complication. Value-based payment models, once they’re set up correctly, will allow us to much more effectively incentivize physicians to improve patient outcomes.

2.) MACRA is the bill you’ve never heard of that will define how physicians are paid

MACRA, the Medicare Access and CHIP Reauthorization Act of 2015, barely received any of the hype that seems to surround healthcare legislation in recent years. This is because the bill primarily affects doctors, and has much less impact on patients. As future physicians, however, this law will literally govern how we are paid. In addition to many much-needed changes – such as eliminating the annual “doc fix” – but it also links payments to quality metrics that must be reported starting in 2017. Over the next decade, performance on quality metrics will adjust payments up or down by up to 9%. This means a hospital or provider group with top scores on quality metrics could be paid nearly 20% more than one with the worst quality scores, for doing the same volume of work!

3.) He offered two suggestions for medical students to thrive in a value-based world

First, and not surprisingly, every medical student should become the best physician that they can. By working hard throughout medical school and residency, we can learn to provide great care to our patients. Second, and less obviously, we should be willing to be evaluated for the quality of our care, learn from these metrics, and identify areas to improve. As quality measures are rolled out, we will have the opportunity to self-reflect and identify areas where we can become even better doctors.

 

The metrics by which quality is measured will constantly be evaluated and improved, and physicians will have the opportunity to contribute to these discussions. In the long term, this system should allow us to (finally) pay for high-value medical care. The result could be a shift from “fee-for-service” to “fee-for-value.”

 

We’re excited to see where Tim goes next, and watch the value-based payment models that he is working on improve the US medical system!

– Logan is a second year medical student at the Perelman School of Medicine. He is the co-VP of curriculum for Penn Health-X, an occasional co-host of the Penn HealthX podcast, and  a contributor to the Penn HealthX blog. You can contact him at  john.brock@uphs.upenn.edu

How to Rate the Podcast!

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Ratings really help us with feedback to make the show better, and helps other people find the show as well! With enough support, we may even get onto a list of top podcasts! We need your help! It only takes a few minutes, tops!

For iTunes:

  1. Open iTunes on your computer.

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  3. In the search bar in the top right, type in “Penn HealthX”

  4. Click on the Picture of our logo in the bottom left corner. Screen Shot 2017-09-05 at 10.13.34 AM

  5. Click on the “Ratings and Reviews” tab on the next screen.Screen Shot 2017-09-05 at 10.15.56 AM

  6. In that tab, click on “Write a Review”Screen Shot 2017-09-05 at 10.19.13 AM

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Podcast App – iPhone

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  8. Choose  unique nickname (with numbers) – this is what will display above your review!

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