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