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- This is Laura Dedo with the
Becker's Healthcare Podcast.

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I'm thrilled today to be joined by Dr.

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Leslie Wong, senior Medical
Director of Medical Specialties,

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as well as Chief Kidney Health Officer

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and Senior Medical Director
of all kidney Services

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and nephrology practices
for Intermountain Health.

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Dr. Wong, it's a pleasure to
have you on the podcast today.

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- Yeah, thank you, Laura. Um, I'm, uh,

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very privileged and honored to be here.

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- Now. I'm really looking
forward to our discussion.

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I know we have a lot to talk about,

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and there's so many exciting
things happening in healthcare

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right now, particularly at Intermountain,

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which has always been on the forefront

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of innovation within the
healthcare delivery space.

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But before we dive into that discussion,

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can you tell us a little bit more

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about yourself and your background?

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- Yeah, absolutely.

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So, um, you know, I, I, I have,
I've got actually, uh, the,

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the fortune of having two, uh, distinct

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and very, um, fulfilling
roles here at Intermountain.

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So I, I lead our medical specialists, so

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that's basically all of the
medical specialties like

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endocrinology, rheumatology,
infectious disease,

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everything except the, um, the, uh,

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interventional like gi cardiology ones.

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Uh, and I also, and with the
original reason I was recruited

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to Intermountain was to lead, uh,

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efforts at improving kidney
health through our system.

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So I, I oversee, uh, the care
of patients with all levels

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of kidney disease,
including on dialysis, uh,

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but all of our nephrology
practices across, um,

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across our networks.

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- Well, that's amazing to hear,

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and I can imagine a really big
job, um, to, to cover such a,

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a broad area that I know
Intermountain covers

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and, um, such an important area too.

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When you think about kidney
care now, what are some

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of the biggest issues that you're

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following in healthcare right now?

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- Yeah, I think it, you know,
again, I I, I'm a bit biased

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because I'm a nephrologist,

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I'm a kidney specialist by trade.

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Uh, but while I say what I
will say from, uh, you know,

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a lot of, um, you know,
inter daily interaction and,

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and just thinking in terms
of, uh, of big picture, uh,

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improvement of healthcare,
uh, you know, I think,

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I think prevention, uh,
ident early identification,

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prevention and, um, you know,
like sustainable strategies

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to address chronic conditions,
uh, which are inclusive

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of kidney disease.

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Uh, but I think really encompass,
uh, the big drivers of,

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uh, you know, mortality,
morbidity, and, and,

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and pain and suffering, right?

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Uh, diabetes, cardiovascular disease,

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obesity, things like that.

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And, and I think, you know, it goes part

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and parcel with the whole idea

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and focus right now on improving

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value in healthcare delivery.

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You know, how do we
actually invest, uh, justify

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and strategize around, um, you
know, using our healthcare,

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our scarce healthcare resources, right?

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To, to reach people where they're at

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and at a point in their, uh,
in their lives where, you know,

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we can actually prevent
these costly events

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from happening, right?

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And prevent people from actually having

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disease and keep them healthy.

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I think that is the
biggest issue that, um,

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not just here in Intermountain,
but across healthcare.

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- That's such an interesting point.

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And certainly, you know, a
huge, huge challenge, uh,

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for communities across the country

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and in the work that you're doing.

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Obviously, there's a lot, um, that, uh,

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the medical community can do,

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but a certain percentage of
it as well is, uh, trying to,

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um, change the behaviors
in, you know, wellness, um,

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activities of the community at large.

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When you look at, um, you know,
those two, I guess, spaces,

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how do you really, are you
really tackling this problem of,

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um, trying to change behaviors

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and really get the
community more in a place

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where you're able to, um, prevent
some of the big challenges

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that can, um, make a big,

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big difference for people's health?

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- No, absolutely. I mean,

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and so looking at, at
disease identification

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and prevention from a, from a global kind

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of societal public health
view, I mean, you know,

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there's certainly a, a great need, um,

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and, um, a great challenge
for us as, as you know,

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the United States, um, to,
um, to, to, to cha, you know,

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to identify those, those
actionable items in terms

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of behavior, which, you
know, unfortunately, a lot

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of those things are, you know, you know,

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we turn them social
determinants of health, right?

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Are, are sometimes beyond
what we as clinicians

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can immediately affect, uh, a change.

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But I think just
acknowledging the importance

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of those things, uh, is, is critical.

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Um, and I do think that there
are these, um, you know,

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people have termed it kind of, um,

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not the social determinants of health,

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but kind of the policy
determinants of health.

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I think those, those actually drive,

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those actually drive our ability

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or inability to address those.

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I would say, um, you know,
while we do want people, right,

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not patients, but people to
be more aware, engaged, um,

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and, and, and, and active in, in,

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in keeping themselves healthy.

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And we know that a lot of that
starts not, not in adulthood

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or in late, you know,
in middle age or, or or

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or older age when people
are actually sick.

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But that starts like
when they're adolescents

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that starts when they're,
you know, children.

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It actually starts, you know,
in the prenatal period, right?

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We can't actually fix all that right now,

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but I think one, one of the
things we can, um, address is

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how do we change behavior
of physicians, of nurses,

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of, um, healthcare leaders

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and administrators so that we're all kind

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of rowing in the same direction?

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And, and, and you know,
I think, Laura, you know,

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I started out in private practice

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and I, I had this very naive
conception of healthcare.

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Um, you know, coming from a, you know,

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from an ac a busy academic
medical center saying, Hey,

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listen, if, you know, if I'm
in practice on my own and,

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and I'm not beholden to the
rules of the medical center

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or hospital, I'll be able
to deliver the kind of care,

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the kind of healthcare that
I think is appropriate.

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And boy, was that a rude
awakening when I, you know, that,

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you know, the first month
in private practice when I

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realized that, you know, the world

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doesn't actually work that way.

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Um, so I think, you know, in
my journey through healthcare,

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uh, through practice working
in industry on a couple

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of occasions, and then, um,
you know, large, um, you know,

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very, very, I think, uh,

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forward thinking health
systems like Cleveland Clinic

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and Intermountain, it's really
given me that perspective

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that, that at the, at the end
of the day, in order for us

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to, to do better for our
patients, to, to create

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that awareness and, and that
policy change, physicians have

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to be front and center in, in,

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in changing their own behavior

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and recognizing what they need

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to do in order to make that happen.

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- That's great to hear it,
and, you know, such a helpful

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and important perspective

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to have from the healthcare
professional community.

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Now, when you look ahead, what
are you most excited about?

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What makes you nervous?

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- Well, you know, I'm
excited about our, you know,

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I think the growing,
uh, not only awareness,

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but the growing, uh, involvement
that, that we as physicians

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and we as healthcare providers have in

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the whole value equation.

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And, and I know that's,
that, that's now kind

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of a hackney term, right?

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Value-based care. But,

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but essentially, you know,
if we're not able to leverage

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a different model of payment,
uh, a different reward system,

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right, in, in healthcare,
we won't be able to sustain

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or motivate people to change.

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So I'm excited by the fact
that, you know, for example,

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at Intermountain Health, we
are, you know, 50% plus, uh, in,

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uh, in value-based payment
arrangements, which, you know,

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it doesn't fix all

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of those social determinants
of health issues.

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It doesn't fix all of the, um,
the behavior change issues,

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um, you know, for our providers

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or for the people we care for,

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but it gives us the opportunity to do so.

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So that's what makes me really excited.

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Um, but what makes me not excited
is the fact that the, the,

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the pace of change

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and the amount of change, even
for someone like me who's,

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you know, really I, you know, I really try

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to dedicate my career at, at
changing healthcare delivery.

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Um, it, it's dizzying.

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So when, you know, when, for example,

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the federal government
has, oh, gosh, you know,

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I think it's like 50
plus a different a CO or,

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or alternative payment models
as they used to be called, uh,

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you know, the frontline
clinician who, who,

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who we really need to buy in
and invest their time, effort

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and, you know, you know,
their, their blood sweat

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and tears into, it's almost over.

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It's almost over it, it's
almost too overwhelming.

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And then you've got a
lot of noise, of course,

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because, um, you know, you've
got big players, uh, outside

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of the traditional healthcare
systems, you know, the Amazons

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of the world, um, the, you
know, the, the, the CVSs and,

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and, and, you know, Walgreens, yes.

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But now, no, you know,

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that are really foreign
into healthcare saying, Hey,

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can we apply a lot of these things

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that have been really successful
in non-healthcare sectors

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and make healthcare more
efficient and effective?

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Um, you know, I think there's
been, I think the jury's out

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because we've seen some
great, um, success,

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but we've also seen, um,
some, some challenges.

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And I think, I think where I,
as a physician, um, you know,

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become concerned is that,
you know, with all the hype

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and hyperbole around, you know,
transforming healthcare and,

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and disrupting healthcare,
you know, who's really in it

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for the long term, right?

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Who's got the, who's got the will, uh,

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or the finances to, to go

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through the ebbs to get to the peak.

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Does that make sense, Laura?

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- Yeah, yeah, that makes a lot of sense.

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You know, and it is a really
fascinating way to approach,

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um, just the healthcare landscape today,

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because as you mentioned, you know,

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it seems like there is huge
opportunity from the traditional

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healthcare space to figure out how

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to do it better and, and deliver better.

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But at the same time, there's
so many complexities that,

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you know, coming from
outside of the industry and,

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and trying to be successful
within healthcare, um,

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given the regulations, giving
the just, um, how, you know,

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important it is to communities
and how necessary it is, um,

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and everything else that
goes along with the,

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the broader healthcare ecosystem.

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It's not easy to do

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and just come into the industry,
um, you know, brand new

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and, and think you're going
to make a big difference.

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So, um, as you mentioned,
we've seen that time

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and time again from different
entrants into the space,

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and some have stuck around

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and some have changed in, in some of,

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you know, left to some degree.

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And so when you look at the
kind of broader space here,

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who do you think is most best positioned?

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Maybe not company by company,

242
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although, you know, I would
love to hear your thoughts on

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that if you have thoughts,

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but really in terms of, you know, um,

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who within the healthcare

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or non-healthcare space can
really make the difference

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that's needed in order to, um,

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deliver better care, if that makes sense?

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- Yeah, I, I, I think I, I think the thing

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that's gonna be really critical, uh, and,

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and part of this actually is shaped

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by some recent conversations
I've had with, um,

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with physician leaders

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and other folks, um, kind of
internationally thinking about,

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um, how they are approaching,
um, you know, healthcare and,

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and, you know, and disease prevention from

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a societal standpoint.

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You know, at the end of
the day, you know, um, you,

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you know, I think payers, um,
I think health systems, um,

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you know, uh, you know,
individual, um, clinicians per, uh,

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uh, you know, um, you know,

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we all have a different stake in things.

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But I think one of the things
that I think will best, um,

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align and ensure commitment, right?

265
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Lasting commitment is
like, how, what is the,

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what is the population, right?

267
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What is the constituency
of, of, of interest?

268
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Because, you know, I, I, now
that I've worked, uh, you know,

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uh, trying to, uh, negotiate
contracts with payers, right?

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But now as part of
Intermountain, you know, we,

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we have our own payer working
inside that, that, um, that

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that structure to, to kind

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of see things from their perspective.

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You know, I realize that it, it, it's

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so much more complex
than what, um, that that

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what you see on the daily show, right?

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Um, but, but what I do think
is that, is there a way

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that we can, um, activate,
um, policy makers

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and officials who have
a, a lack, you know,

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have a commitment to their
community now beyond, and,

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and again, and involve the
communities in terms of

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how they want to approach these things.

283
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Because I, I think at the end
of the day, um, you know, as,

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as, as, as bullish I, as I've
been in the past in, in terms

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of, uh, participating in, you know,

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in these new payment models

287
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and whatnot, you know,
these are kind of things

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that are dictated by the
length of a contract, right?

289
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Maybe five years or so.

290
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We really need to start thinking about

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how do we integrate a
sequence of these types

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of contractual arrangements,
connect the dots

293
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so we have a more
longitudinal, holistic view of

294
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how we wanna approach health.

295
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Um, and I, I think the big
thing is, you know, obviously

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until we stop, you know,
until we stop the bleeding

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or the, for these things like
high cost hospitalizations,

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readmissions, you know, preventable
events like for example,

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in the kidney space, people,
um, you know, showing up and,

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and the first time they see
a kidney specialist is when

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they, they start dialysis in the,

302
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in the intensive care unit.

303
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Those are things that if we can, we need

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to eliminate those things.

305
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'cause they are the low,
low lowest hanging fruit,

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although they're not easy to address.

307
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But I think we need to work part

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and par parcel with, you
know, across a broad, um,

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array of stakeholders.

310
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So again, whether those are the leaders

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of our health systems, people
in industry, people who, who,

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uh, are in public policy,

313
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but also our, our, our, our,

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you know, the people in the communities.

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I think, I think ultimately
healthcare, you know, we,

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we keep hearing as a consumer
driven industry, uh, I've yet

317
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to actually see that
consumers exercise their full

318
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power in terms of
influencing how we invest in,

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in keeping them, keeping them healthy.

320
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- That's such a great point.

321
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And definitely, you know,
fascinating to see how everything,

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you know, will play out
over the next few years.

323
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And speaking of these
changing market dynamics

324
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and certainly, um, you know,
where healthcare is headed,

325
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what do you think, um,

326
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most effective healthcare
leaders will need in order

327
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to be successful over the
two to three years, um,

328
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in the future, especially
as I mentioned, thinking

329
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through these changes in what really, um,

330
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will make the biggest difference?

331
00:14:01,185 --> 00:14:02,595
- Yeah, I, that, that's,

332
00:14:02,595 --> 00:14:05,435
that's actually such a
foundational question and, and,

333
00:14:05,435 --> 00:14:06,795
and that ties this all together.

334
00:14:07,215 --> 00:14:10,475
You know, Laura, um, earlier
in my career, I, I, I was, um,

335
00:14:10,655 --> 00:14:15,075
the VP of, of quality, um, at,
uh, an indu for a, a company,

336
00:14:15,075 --> 00:14:16,875
an industry in the, in the
kidney health industry.

337
00:14:17,535 --> 00:14:21,955
And, um, I, I, I really, really,
um, learned so much about,

338
00:14:22,175 --> 00:14:24,955
uh, about, uh, you know,
Deming's teachings, quality,

339
00:14:25,215 --> 00:14:27,115
you know, focus on the
process, not the people.

340
00:14:27,615 --> 00:14:29,795
But now as I, you know,
20 years later as I,

341
00:14:29,855 --> 00:14:32,195
as I look back at, at,
at what I've experienced,

342
00:14:32,195 --> 00:14:33,635
and now looking at the landscape,

343
00:14:34,235 --> 00:14:36,515
I think process is
obviously really important.

344
00:14:36,815 --> 00:14:39,915
We need to double down,
triple down on the people, um,

345
00:14:40,055 --> 00:14:41,395
the pandemic, as you know,

346
00:14:41,395 --> 00:14:44,555
and I won't recapitulate what
we know is, you know, put,

347
00:14:44,615 --> 00:14:48,795
you know, it was really so,
oh gosh, so, um, so harmful

348
00:14:49,055 --> 00:14:52,245
to our, our caregivers,
physicians, nurses, other,

349
00:14:52,245 --> 00:14:54,125
other folks that are, you
know, taking care of people,

350
00:14:54,225 --> 00:14:56,045
you know, in, in the pandemic and whatnot.

351
00:14:56,625 --> 00:14:59,765
And so now we are in this,
um, you know, kind of,

352
00:14:59,885 --> 00:15:02,485
I guess we're still, I guess
we're post pandemic now,

353
00:15:02,665 --> 00:15:04,245
but you know, the, the, the economics

354
00:15:04,245 --> 00:15:07,285
and finances ha are are back
front and center, and they're,

355
00:15:07,285 --> 00:15:10,405
and they're making health
systems, including Intermountain,

356
00:15:10,625 --> 00:15:13,045
you know, have to make some
really tough, you know, choices.

357
00:15:13,765 --> 00:15:17,045
I, I think keeping our,
our people whole, um,

358
00:15:17,265 --> 00:15:19,205
and ensuring, um, not, not just,

359
00:15:19,705 --> 00:15:22,525
not just having an initiative
for employee wellness,

360
00:15:22,905 --> 00:15:24,965
but truly looking at the near

361
00:15:25,025 --> 00:15:26,645
and long-term needs of the people

362
00:15:26,645 --> 00:15:28,605
that have dedicated their
lives to healthcare.

363
00:15:29,345 --> 00:15:31,565
That's what an effective
leader needs to do.

364
00:15:32,005 --> 00:15:34,165
'cause without the people,
it's not gonna happen.

365
00:15:36,095 --> 00:15:38,135
- Absolutely. I love that.
Dr. Wong, thank you so much

366
00:15:38,135 --> 00:15:39,615
for joining us on the podcast today.

367
00:15:39,615 --> 00:15:41,455
This has been a fascinating discussion,

368
00:15:41,455 --> 00:15:43,135
and I look forward to
connecting with you again soon.

369
00:15:43,905 --> 00:15:46,155
- Yeah, thank you, Laura.
Again, thank you so much, uh,

370
00:15:46,155 --> 00:15:48,835
to Beckers for inviting me
to, uh, share my thoughts.