1 00:00:00,120 --> 00:00:02,940 Thank you for listening to the Becker's Healthcare Podcast. I'm Molly Gamble, 2 00:00:02,960 --> 00:00:06,420 and today I have the chance to spend time with Dr. David Calender. Dr. 3 00:00:06,420 --> 00:00:08,980 Calender is president and c e o of Memorial Hermann. 4 00:00:09,080 --> 00:00:11,540 He joined the system in this capacity in 2019. 5 00:00:12,220 --> 00:00:15,660 Memorial Hermann includes 17 hospitals, more than 250 sites of care, 6 00:00:15,800 --> 00:00:19,980 nearly 30,000 employees and 6,500 affiliate physicians. 7 00:00:20,720 --> 00:00:24,620 Dr. Calender is an e n T surgeon who specializes in head and neck cancers. 8 00:00:24,640 --> 00:00:27,940 He earned his medical degree from Baylor College of Medicine and completed his 9 00:00:27,940 --> 00:00:30,420 fellowship with MD Anderson. Dr. Calender, 10 00:00:30,420 --> 00:00:33,540 thank you so much for joining me today. How are you? Where do we find you? 11 00:00:34,990 --> 00:00:36,480 Well, thank you very much, Molly. 12 00:00:36,480 --> 00:00:39,960 It's great to have this opportunity to speak with you today. Um, 13 00:00:40,230 --> 00:00:44,640 looking forward to talking a little bit more about what the value 14 00:00:45,370 --> 00:00:47,840 means or should mean within healthcare. 15 00:00:49,180 --> 00:00:49,500 Yes. 16 00:00:49,500 --> 00:00:53,360 We are devoting our time to talking about a really important word that I feel 17 00:00:53,360 --> 00:00:58,200 like used to circulate much more fre frequently when discussing healthcare about 18 00:00:58,220 --> 00:01:02,720 10 years ago. That is value today, at least from my seat. And I'm, you know, 19 00:01:02,780 --> 00:01:05,440 in media, I'm not on the ground like you are Dr. Calendar, 20 00:01:05,460 --> 00:01:08,400 but it seems like that concept, you know, prices, 21 00:01:08,660 --> 00:01:11,240 you hear a good amount of attention paid around that, 22 00:01:11,240 --> 00:01:13,840 especially with the transparency regulations that went to effect. 23 00:01:14,230 --> 00:01:17,520 Same with costs amid inflation especially, 24 00:01:17,980 --> 00:01:21,520 but value not as much. Do you see the same from your seat, 25 00:01:21,540 --> 00:01:22,600 or do you see it differently? 26 00:01:24,500 --> 00:01:29,260 I, I, I do. I see it, uh, essentially the same way I, I, I think the one, 27 00:01:30,360 --> 00:01:31,193 um, 28 00:01:31,760 --> 00:01:36,580 con set of conversations that we're having in healthcare that do 29 00:01:36,580 --> 00:01:41,020 involve the term value, uh, really, um, 30 00:01:41,130 --> 00:01:44,860 seem to focus on value-based reimbursement, 31 00:01:45,480 --> 00:01:49,740 but even that oftentimes is unclear or may have multiple 32 00:01:50,060 --> 00:01:53,940 meanings to the different participants in a conversation. 33 00:01:54,920 --> 00:01:56,060 So yeah, it's, 34 00:01:56,060 --> 00:02:00,460 it's something that we need to talk more about and I think considering all of 35 00:02:00,460 --> 00:02:02,980 the underlying issues in US healthcare today, 36 00:02:03,040 --> 00:02:07,900 we need to be much more focused on as we go forward with a much more precise 37 00:02:07,910 --> 00:02:09,420 definition. Mm-hmm. . 38 00:02:10,520 --> 00:02:11,740 I'm so glad you brought that up, 39 00:02:11,820 --> 00:02:14,380 cuz sometimes that apples and oranges effect can happen, 40 00:02:14,480 --> 00:02:19,220 people using the same term in different ways. So how do you define value? Uh, 41 00:02:19,400 --> 00:02:21,060 can you share how you think about it? 42 00:02:22,710 --> 00:02:24,840 Yeah, we, we think, uh, 43 00:02:24,890 --> 00:02:29,680 value is defined by the Quinn Couple aim in 44 00:02:29,680 --> 00:02:30,840 healthcare. You know, 45 00:02:31,000 --> 00:02:34,960 I think many of us who have been around for a little bit longer, 46 00:02:35,520 --> 00:02:38,040 remember the Institute for Healthcare's Improvement. 47 00:02:38,540 --> 00:02:42,680 All of its great work in the 1990s and early two thousands. 48 00:02:42,860 --> 00:02:47,680 And it's coining of the phrase, and certainly they did this with many others, 49 00:02:48,020 --> 00:02:49,040 but the aaa, 50 00:02:49,690 --> 00:02:54,680 which really was focused on decreasing cost, improving outcomes, 51 00:02:54,680 --> 00:02:56,560 particularly for populations, 52 00:02:57,380 --> 00:03:01,860 and enhancing the overall experience of the patient or or healthcare 53 00:03:02,340 --> 00:03:05,500 consumer. Through the course of time, uh, you know, 54 00:03:05,500 --> 00:03:07,540 a lot of people engaged in that. We, 55 00:03:07,600 --> 00:03:11,300 we added the element of the experience of healthcare workers 56 00:03:12,240 --> 00:03:16,820 that's so important in terms of the delivery of high value care. 57 00:03:17,600 --> 00:03:22,540 And then more recently is we've more carefully and thoroughly considered 58 00:03:22,560 --> 00:03:24,700 the status of healthcare in this, this country. 59 00:03:24,960 --> 00:03:29,860 All of the disparities in delivery of healthcare, 60 00:03:30,090 --> 00:03:34,860 even in, um, a access to great health, um, 61 00:03:34,860 --> 00:03:35,660 we said, well, gosh, 62 00:03:35,660 --> 00:03:39,580 it's really a quintuple aim with health equity being that fifth piece. 63 00:03:40,400 --> 00:03:43,020 So at Memorial Hermann, we think about, uh, 64 00:03:43,020 --> 00:03:47,900 the quintuple aim as essentially defining the road to 65 00:03:48,030 --> 00:03:51,420 value. And so it makes it a little easier for us to, uh, 66 00:03:51,600 --> 00:03:55,340 as we think about the elements of the, of the quintuple aim to think about, 67 00:03:55,370 --> 00:03:58,500 okay, where should we be focused and what should we be doing? 68 00:03:59,240 --> 00:04:00,380 Mm-hmm. . Mm-hmm. . 69 00:04:01,080 --> 00:04:04,180 And then when you think about sometimes Dr. Calendar, I find it helpful too, 70 00:04:04,180 --> 00:04:07,900 just as there's a definition of what something does include or encompass or 71 00:04:07,900 --> 00:04:09,460 touch. What does it not, you know, 72 00:04:09,650 --> 00:04:13,380 does your definition of value or the way you think about it and your philosophy, 73 00:04:13,450 --> 00:04:17,900 does it actively exclude anything? Are there any perhaps things that we, 74 00:04:17,920 --> 00:04:21,220 you wanna make sure that we aren't conflating when it comes to how we talk about 75 00:04:21,230 --> 00:04:22,063 value? 76 00:04:23,330 --> 00:04:26,500 Well, I, you know, I think if we think about in terms of the Quint aim, 77 00:04:26,610 --> 00:04:27,980 it's pretty inclusive. 78 00:04:29,180 --> 00:04:33,860 I think the things that we want to avoid are, um, uh, 79 00:04:34,000 --> 00:04:38,580 points of focus on single elements that drive value, 80 00:04:38,810 --> 00:04:40,540 like price or cost. 81 00:04:40,640 --> 00:04:45,420 We don't want to race to the bottom with a focus just on price. 82 00:04:46,320 --> 00:04:48,500 So, uh, uh, you know, we, um, 83 00:04:48,760 --> 00:04:51,900 as we think about that quintuple aim and how we use value, 84 00:04:51,960 --> 00:04:56,060 we actually have a high level set of strategic 85 00:04:56,330 --> 00:05:00,540 initiatives that are defined by the acronym health, 86 00:05:00,940 --> 00:05:02,340 H A L T H. 87 00:05:03,480 --> 00:05:06,540 And so let me just tell you what each of those represent to us, 88 00:05:06,840 --> 00:05:11,660 and then I think you'll better understand the concept and how we use it and how 89 00:05:11,660 --> 00:05:15,420 it really is inclusive. But also, um, you know, 90 00:05:15,420 --> 00:05:16,860 all of those elements are linked. 91 00:05:16,960 --> 00:05:20,500 So h is for humanize every experience, 92 00:05:20,720 --> 00:05:25,020 and of course that gets to the experience of consumers as well as people who 93 00:05:25,020 --> 00:05:26,460 participate in the system. 94 00:05:27,380 --> 00:05:31,180 E is for enable high reliability care, 95 00:05:31,360 --> 00:05:36,140 we really need to be focused on quality on what we are delivering 96 00:05:36,400 --> 00:05:41,380 and make sure that we're doing that in the most effective way A is 97 00:05:41,530 --> 00:05:45,940 aligned with our providers, physicians, all the different providers, 98 00:05:45,940 --> 00:05:49,700 nurses who practice in our facilities. Very importantly, 99 00:05:49,700 --> 00:05:52,620 we all have the same mindset and approach. 100 00:05:52,760 --> 00:05:57,660 We understand what we're trying to do l lower the cost of care, 101 00:05:57,990 --> 00:06:01,980 think about how we become more efficient, how we reduce variability, 102 00:06:02,640 --> 00:06:07,300 how we use the resources that are available to us to deliver the 103 00:06:07,370 --> 00:06:12,020 very best products at the optimal cost. T is transitioned to value. 104 00:06:12,360 --> 00:06:16,100 Now that could be, if you look at that statement on its own, 105 00:06:16,160 --> 00:06:19,540 be a little confusing because of, you know, the, 106 00:06:19,600 --> 00:06:22,380 the issue of what does value really mean. But in our case, 107 00:06:22,410 --> 00:06:26,260 it's really talking about move towards value based reimbursement, 108 00:06:27,120 --> 00:06:32,100 taking more risk thinking about how we can do that and do that 109 00:06:32,100 --> 00:06:32,933 effectively. 110 00:06:33,210 --> 00:06:37,940 Because we think if we can do that as a moderate sized health 111 00:06:37,940 --> 00:06:42,580 system in a large urban area, we can reduce the cost of purchasers, 112 00:06:43,330 --> 00:06:46,420 both, uh, employers, governmental agencies, 113 00:06:46,520 --> 00:06:50,540 as well as those who purchase healthcare coverage from one of the exchanges. 114 00:06:51,050 --> 00:06:55,260 Finally, h the last H harness smart growth. 115 00:06:56,050 --> 00:07:00,980 What that really signifies is that we know we need to grow not so much in terms 116 00:07:00,980 --> 00:07:03,580 of physical size. Now, 117 00:07:04,250 --> 00:07:07,780 some physical growth is important for us here in Houston because Houston can 118 00:07:07,940 --> 00:07:11,140 continues to grow quite dramatically. 119 00:07:11,640 --> 00:07:15,300 But what we're really talking about is a growth in our capabilities, 120 00:07:15,550 --> 00:07:19,980 doing that on our own, and in combination affiliation, 121 00:07:20,420 --> 00:07:25,100 collaboration arrangements with partners who bring the opportunity to 122 00:07:25,100 --> 00:07:29,740 deliver services on a more cost efficient basis and 123 00:07:29,900 --> 00:07:32,940 produce better outcomes. So, you know, again, 124 00:07:33,530 --> 00:07:36,940 that health-based acronym's pretty inclusive, 125 00:07:38,200 --> 00:07:42,220 but the reason we like the acronym is cuz it says all of this needs to be in 126 00:07:42,220 --> 00:07:42,640 existence. 127 00:07:42,640 --> 00:07:47,380 We need to do all of these things if truly we're going to drive value to the 128 00:07:47,400 --> 00:07:49,380 people that we serve here in Greater Houston. 129 00:07:49,800 --> 00:07:51,300 Mm-hmm. , it's easy to remember. 130 00:07:51,460 --> 00:07:56,220 I I love that and I love how inclusive and intentional this philosophy is, Dr. 131 00:07:56,580 --> 00:07:59,420 Calendar. And it brings me to thinking about if, 132 00:07:59,720 --> 00:08:03,820 if I were a consumer or a physician or a healthcare worker, I, I am, 133 00:08:03,920 --> 00:08:08,460 I'm trying to find health systems in the country that are really deliberate and 134 00:08:08,460 --> 00:08:11,580 intentional about value such as Memorial Hermann. You know, 135 00:08:11,580 --> 00:08:12,860 there's no shortage of rankings, 136 00:08:12,860 --> 00:08:14,860 ratings out there available to the general public, 137 00:08:15,240 --> 00:08:20,140 but do we have a unified or agreed upon way to assess value 138 00:08:20,240 --> 00:08:25,140 in healthcare? And if not, what could that end up looking like? 139 00:08:26,660 --> 00:08:29,100 ? Well, you know, some of those, um, 140 00:08:29,400 --> 00:08:33,140 groups that operate those systems might disagree with me, 141 00:08:34,000 --> 00:08:38,940 but I don't think we really have a great system today. You know, 142 00:08:38,940 --> 00:08:42,540 a number of different groups try to define, um, 143 00:08:42,850 --> 00:08:46,660 high quality and provide rankings or scores. 144 00:08:47,640 --> 00:08:52,500 Others, um, say they're focused on value. The challenge is, 145 00:08:53,400 --> 00:08:53,990 you know, there, 146 00:08:53,990 --> 00:08:58,420 there really aren't a good set of metrics which are easily 147 00:08:58,690 --> 00:09:03,540 applied across the system to help us come to uniform 148 00:09:03,980 --> 00:09:06,700 determinations about what represents value. 149 00:09:07,500 --> 00:09:10,380 I realize that's a long and complicated statement, 150 00:09:10,380 --> 00:09:14,460 but I think that's where we are today. I, I think a, 151 00:09:14,640 --> 00:09:18,140 as health organizations go forward, it, 152 00:09:18,240 --> 00:09:22,860 it really is on us to do a better job of 153 00:09:23,260 --> 00:09:27,380 defining the metrics that truly describe value. You know, 154 00:09:27,380 --> 00:09:31,580 how you take all of these different attributes and initiatives that we describe 155 00:09:31,730 --> 00:09:35,140 with our health-based acronym, uh, 156 00:09:35,560 --> 00:09:38,500 our health acronym and, and, uh, you know, 157 00:09:38,700 --> 00:09:41,020 describe the outcomes that we're generating. 158 00:09:41,320 --> 00:09:46,020 So some things are out there today that are pretty reasonable, 159 00:09:46,200 --> 00:09:48,300 but I don't think we're quite there yet. Mm-hmm. , 160 00:09:48,400 --> 00:09:53,380 and it's really on us as the principal drivers in the healthcare 161 00:09:53,380 --> 00:09:58,220 system delivery system to do a better job of defining where we're going and 162 00:09:58,220 --> 00:10:00,060 what success looks like. Mm-hmm. 163 00:10:00,100 --> 00:10:01,940 , you know, the, the other thing too, 164 00:10:01,940 --> 00:10:06,780 in addition to value dropping off the radar a bit compared to a few years ago, 165 00:10:06,840 --> 00:10:11,100 the other thing I I've thought about too is there's a shortage of so much, 166 00:10:11,240 --> 00:10:14,540 so much is scarce in healthcare, but at the same time, 167 00:10:14,720 --> 00:10:17,820 overutilization is still a problem. And, 168 00:10:17,840 --> 00:10:20,700 and I wanted to get your take on this Dr. Calendar, you know, 169 00:10:20,720 --> 00:10:23,500 one way of looking at value is best outcomes, best price. 170 00:10:24,010 --> 00:10:26,700 When we talk about value as a really lofting, 171 00:10:26,700 --> 00:10:28,660 admirable goal for healthcare organizations, 172 00:10:28,820 --> 00:10:31,060 I also wanna talk about it in the day-to-day. You know, 173 00:10:31,060 --> 00:10:34,740 I'm gonna provide an example, and it actually is in your specialty. I, 174 00:10:34,860 --> 00:10:39,740 I was visiting one healthcare system in my home city that I would come 175 00:10:39,740 --> 00:10:42,020 to find. I, I, I saw it as test happy. 176 00:10:42,480 --> 00:10:47,100 And then one in which the specialist I saw an E N T surgeon actually advised me 177 00:10:47,100 --> 00:10:51,420 to cancel tests and imaging that another physician had ordered because he was so 178 00:10:51,420 --> 00:10:52,820 confident in his diagnosis. 179 00:10:53,520 --> 00:10:58,340 But I only had the information to discern what test hap can look like 180 00:10:58,400 --> 00:11:02,260 and what high value can look like after those two separate and distinct 181 00:11:02,260 --> 00:11:03,460 appointments had occurred. 182 00:11:04,480 --> 00:11:09,300 Is that distinction something patients can inevitably only 183 00:11:09,330 --> 00:11:12,940 make downstream after their encounters unfold? 184 00:11:13,440 --> 00:11:17,300 Or do you feel like there's some information that you can start to look at 185 00:11:17,300 --> 00:11:21,060 utilization rates or feel confident in your physician to decision making when it 186 00:11:21,060 --> 00:11:25,420 comes to the most, the best outcome at the, in the most efficient way? 187 00:11:27,710 --> 00:11:28,760 Yeah, you know, that's, 188 00:11:29,960 --> 00:11:33,120 I think that's one of the dilemmas today. Again, 189 00:11:33,120 --> 00:11:37,520 we don't have good systems that really describe 190 00:11:37,930 --> 00:11:38,640 value. 191 00:11:38,640 --> 00:11:43,360 I think all of us who are in the business of offering better 192 00:11:43,420 --> 00:11:48,400 health and trying to, uh, improve access to healthcare use, 193 00:11:48,740 --> 00:11:53,260 um, healthcare delivery to improve the health of individual patients, you know, 194 00:11:53,260 --> 00:11:57,980 have to take on this challenge, um, more effectively than we have in the past. 195 00:11:58,760 --> 00:12:00,820 It, it, it really is, uh, 196 00:12:00,820 --> 00:12:05,820 sort of an after the fact determination situation for many patients. 197 00:12:06,220 --> 00:12:07,660 I think, you know, you know, 198 00:12:08,020 --> 00:12:12,100 patients can actually look to some of the 199 00:12:12,680 --> 00:12:16,100 health systems in which their, uh, 200 00:12:16,100 --> 00:12:18,860 physicians participate. Um, 201 00:12:19,170 --> 00:12:23,620 they can get a sense of how health systems 202 00:12:24,060 --> 00:12:27,700 approach delivery of services and what seems to be important, 203 00:12:28,530 --> 00:12:32,420 perhaps get a sense of value. But I, I think you're right. Again, 204 00:12:32,420 --> 00:12:35,940 we just don't have a, any good system today for a patient, 205 00:12:35,940 --> 00:12:39,500 individual patient to use to say, you know what? 206 00:12:39,500 --> 00:12:42,620 I'm gonna choose this provider over the other because I want somebody that's 207 00:12:42,620 --> 00:12:46,900 really focused on delivering the highest value service to me. Uh, 208 00:12:46,900 --> 00:12:50,860 the other side of the, the coin, if you will, as a provider, 209 00:12:51,310 --> 00:12:56,180 every patient's different and what's high value for one is not likely 210 00:12:56,280 --> 00:13:01,020 to be high value for the next. So, uh, particularly as you know, 211 00:13:01,260 --> 00:13:05,340 patients have present to us with more complex diseases. So it's, uh, 212 00:13:05,730 --> 00:13:08,620 it's a complicated problem. And again, 213 00:13:08,620 --> 00:13:11,900 I think we all have to continue to work on it to come up with, uh, 214 00:13:11,900 --> 00:13:16,380 better solutions, better offerings for patients as we go forward. Mm-hmm. 215 00:13:16,420 --> 00:13:19,620 , well, let's bring in the payers here, right? 216 00:13:19,620 --> 00:13:22,060 Cause you'd be remiss not to make mention of this stakeholder. 217 00:13:22,600 --> 00:13:27,540 Do you feel as though payers and health systems see value any closer 218 00:13:27,720 --> 00:13:31,460 to eye to eye today than in years past? And if not, 219 00:13:31,560 --> 00:13:33,180 how do those perspectives differ today? 220 00:13:35,890 --> 00:13:37,940 Yeah, I think at a very high level, we do. 221 00:13:38,420 --> 00:13:43,060 I think there are really none among us, between, 222 00:13:43,120 --> 00:13:47,940 you take payers and providers who will argue that the US healthcare system is 223 00:13:47,940 --> 00:13:51,380 highly efficient in producing the level of outcomes that we need to produce, 224 00:13:51,700 --> 00:13:55,980 particularly based on the amount of investment that we make every year. Uh, 225 00:13:56,060 --> 00:13:59,300 I think, you know, our points of focus for, uh, 226 00:13:59,620 --> 00:14:02,540 providers are a little different than they are for the payers, 227 00:14:03,600 --> 00:14:07,700 but ultimately, if we're going to drive value, 228 00:14:08,620 --> 00:14:12,580 I think the, the payers and providers need to be more aligned. 229 00:14:12,720 --> 00:14:16,540 And I think we're seeing that today. I think we're seeing, um, 230 00:14:16,820 --> 00:14:21,380 providers systems like ours who are working closely with one or more payers 231 00:14:21,980 --> 00:14:26,380 thinking about, gosh, what can we do together? What information do we have? 232 00:14:26,380 --> 00:14:30,620 What information do you have? What populations can we focus on? 233 00:14:30,620 --> 00:14:34,860 Where do we know that there are significant opportunities for improvement? 234 00:14:35,330 --> 00:14:37,900 What are your ideas about that? What are hours about that? 235 00:14:37,900 --> 00:14:40,820 Let's see if we can put those together and come up with a better approach. 236 00:14:40,820 --> 00:14:45,140 Certainly we're excited about some of those opportunities that we have here in 237 00:14:45,140 --> 00:14:49,500 Houston, and we think there will be more as we go forward. So yes, 238 00:14:49,620 --> 00:14:50,900 I think we're moving in that direction. 239 00:14:52,900 --> 00:14:56,080 Is there anything on the topic of value that we haven't touched on yet, 240 00:14:56,100 --> 00:14:56,933 but we should? 241 00:14:59,120 --> 00:15:03,360 I, I think, you know, for health systems in particular today, 242 00:15:04,380 --> 00:15:07,760 no matter which market, um, 243 00:15:08,030 --> 00:15:11,360 that you're engaged with, that, you know, 244 00:15:11,360 --> 00:15:16,240 you've got some straight fee for service arrangements 245 00:15:16,300 --> 00:15:20,720 and situations, probably have some risk based arrangements, 246 00:15:20,780 --> 00:15:22,360 and you've got everything in between. 247 00:15:24,020 --> 00:15:28,960 So question that often comes up among leaders of health system is how, 248 00:15:28,960 --> 00:15:33,320 how do we navigate this? How do we keep a foot in both camps, 249 00:15:33,620 --> 00:15:36,400 if you will, you know, how do we, um, 250 00:15:36,920 --> 00:15:38,640 navigate this transition? 251 00:15:39,390 --> 00:15:43,520 Some people are using the phrase cross the Rubicon , but you know, 252 00:15:44,020 --> 00:15:44,520 do it in, 253 00:15:44,520 --> 00:15:49,080 in a logical way considering that we have to deliver, 254 00:15:49,340 --> 00:15:53,200 uh, high value fee for service. Um, and, 255 00:15:53,200 --> 00:15:58,200 and we have to deliver high value, um, you know, service in a value based world. 256 00:15:59,060 --> 00:16:01,080 So to, to address that, 257 00:16:01,080 --> 00:16:05,800 what we've done here at Memorial Hermann is created what we call our no regret 258 00:16:06,090 --> 00:16:06,923 strategies. 259 00:16:07,620 --> 00:16:12,400 And these are the initiatives that endeavors the efforts 260 00:16:13,190 --> 00:16:16,360 that we think drive high quality and lower costs, 261 00:16:16,740 --> 00:16:21,400 but work in a traditional fee for service world as well as in the value-based 262 00:16:21,680 --> 00:16:25,440 reimbursement world. So to us, that means that, okay, 263 00:16:25,440 --> 00:16:30,320 we need to manage every cost that we can control, optimize those costs, 264 00:16:31,360 --> 00:16:36,160 continue to innovate with regard to the models that we 265 00:16:36,160 --> 00:16:40,160 have with payers. We just talked about that we need to focus, 266 00:16:40,160 --> 00:16:44,720 make sure that we maintain our focus on patients and, and not get, 267 00:16:45,140 --> 00:16:48,360 um, caught up in thinking about sites of service. 268 00:16:48,620 --> 00:16:52,880 We really need to keep that principle focused on the patients. Um, clearly, 269 00:16:53,940 --> 00:16:57,440 um, we need a lot of help. We need great tool sets, 270 00:16:57,620 --> 00:17:02,120 so think about partners, technology partners, um, 271 00:17:02,140 --> 00:17:04,240 new investment partners, 272 00:17:04,410 --> 00:17:09,040 other investment opportunities that can accelerate 273 00:17:09,220 --> 00:17:12,800 our efforts to move down this road towards higher value. 274 00:17:13,940 --> 00:17:15,920 And finally, um, you know, 275 00:17:15,920 --> 00:17:20,760 be very proactive in our communities a and think about what does 276 00:17:20,820 --> 00:17:22,480 access to health look like? 277 00:17:23,150 --> 00:17:26,650 What does good health maintenance look like? 278 00:17:27,650 --> 00:17:32,390 Do our very best to engage on our own and with others in the community 279 00:17:32,890 --> 00:17:35,190 to try to promote good health. 280 00:17:35,730 --> 00:17:40,310 Do our best actually to keep people from developing high intensity 281 00:17:40,720 --> 00:17:45,070 acute illness are, um, waiting, um, 282 00:17:45,850 --> 00:17:47,870 in terms of coming forward with, uh, 283 00:17:48,110 --> 00:17:52,540 symptoms of a chronic illness so that they get to the point where they're quite 284 00:17:52,720 --> 00:17:56,860 ill and require very expensive care. So, uh, again, 285 00:17:56,860 --> 00:18:00,460 we think these are the sorts of things, the sorts of ideas, 286 00:18:00,600 --> 00:18:02,620 the sorts of efforts that work, 287 00:18:02,620 --> 00:18:05,940 whether you're focused on fee for service or whether you're focused on value, 288 00:18:06,070 --> 00:18:10,220 value based reimbursement. Considering where we are today, 289 00:18:10,440 --> 00:18:14,780 we think having a set of no regret strategies is very important to success. 290 00:18:15,160 --> 00:18:17,720 Mm-hmm. , Dr. David, er, 291 00:18:17,760 --> 00:18:19,680 I wanna thank you for spending some time with me, 292 00:18:19,680 --> 00:18:22,560 president and c e o of Memorial Harman talking about value. 293 00:18:23,120 --> 00:18:25,520 I think an important conversation always, 294 00:18:25,620 --> 00:18:29,600 but I imagine especially as some of the financial pressures that have affected 295 00:18:29,600 --> 00:18:31,800 healthcare providers over the past year, 296 00:18:31,820 --> 00:18:34,960 and so start to show up more in contract negotiations, 297 00:18:35,030 --> 00:18:38,280 perhaps passed down to consumers and premiums. 298 00:18:38,430 --> 00:18:40,520 Just a really important time to be revisiting this topic. 299 00:18:40,740 --> 00:18:45,280 So I wanna thank you for the opportunity to explore it in more detail with you. 300 00:18:46,760 --> 00:18:47,593 Well, thank you Molly, 301 00:18:47,670 --> 00:18:51,970 and enjoyed the conversation and hopefully be helpful to others as we all 302 00:18:51,970 --> 00:18:56,970 contemplate how we move forward and drive to this concept of higher value, 303 00:18:57,770 --> 00:18:59,530 improved outcomes at optimal cost.