- This is Laura Dedo with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Dr.
Leslie Wong, senior Medical Director of Medical Specialties,
as well as Chief Kidney Health Officer
and Senior Medical Director of all kidney Services
and nephrology practices for Intermountain Health.
Dr. Wong, it's a pleasure to have you on the podcast today.
- Yeah, thank you, Laura. Um, I'm, uh,
very privileged and honored to be here.
- Now. I'm really looking forward to our discussion.
I know we have a lot to talk about,
and there's so many exciting things happening in healthcare
right now, particularly at Intermountain,
which has always been on the forefront
of innovation within the healthcare delivery space.
But before we dive into that discussion,
can you tell us a little bit more
about yourself and your background?
- Yeah, absolutely.
So, um, you know, I, I, I have, I've got actually, uh, the,
the fortune of having two, uh, distinct
and very, um, fulfilling roles here at Intermountain.
So I, I lead our medical specialists, so
that's basically all of the medical specialties like
endocrinology, rheumatology, infectious disease,
everything except the, um, the, uh,
interventional like gi cardiology ones.
Uh, and I also, and with the original reason I was recruited
to Intermountain was to lead, uh,
efforts at improving kidney health through our system.
So I, I oversee, uh, the care of patients with all levels
of kidney disease, including on dialysis, uh,
but all of our nephrology practices across, um,
across our networks.
- Well, that's amazing to hear,
and I can imagine a really big job, um, to, to cover such a,
a broad area that I know Intermountain covers
and, um, such an important area too.
When you think about kidney care now, what are some
of the biggest issues that you're
following in healthcare right now?
- Yeah, I think it, you know, again, I I, I'm a bit biased
because I'm a nephrologist,
I'm a kidney specialist by trade.
Uh, but while I say what I will say from, uh, you know,
a lot of, um, you know, inter daily interaction and,
and just thinking in terms of, uh, of big picture, uh,
improvement of healthcare, uh, you know, I think,
I think prevention, uh, ident early identification,
prevention and, um, you know, like sustainable strategies
to address chronic conditions, uh, which are inclusive
of kidney disease.
Uh, but I think really encompass, uh, the big drivers of,
uh, you know, mortality, morbidity, and, and,
and pain and suffering, right?
Uh, diabetes, cardiovascular disease,
obesity, things like that.
And, and I think, you know, it goes part
and parcel with the whole idea
and focus right now on improving
value in healthcare delivery.
You know, how do we actually invest, uh, justify
and strategize around, um, you know, using our healthcare,
our scarce healthcare resources, right?
To, to reach people where they're at
and at a point in their, uh, in their lives where, you know,
we can actually prevent these costly events
from happening, right?
And prevent people from actually having
disease and keep them healthy.
I think that is the biggest issue that, um,
not just here in Intermountain, but across healthcare.
- That's such an interesting point.
And certainly, you know, a huge, huge challenge, uh,
for communities across the country
and in the work that you're doing.
Obviously, there's a lot, um, that, uh,
the medical community can do,
but a certain percentage of it as well is, uh, trying to,
um, change the behaviors in, you know, wellness, um,
activities of the community at large.
When you look at, um, you know, those two, I guess, spaces,
how do you really, are you really tackling this problem of,
um, trying to change behaviors
and really get the community more in a place
where you're able to, um, prevent some of the big challenges
that can, um, make a big,
big difference for people's health?
- No, absolutely. I mean,
and so looking at, at disease identification
and prevention from a, from a global kind
of societal public health view, I mean, you know,
there's certainly a, a great need, um,
and, um, a great challenge for us as, as you know,
the United States, um, to, um, to, to, to cha, you know,
to identify those, those actionable items in terms
of behavior, which, you know, unfortunately, a lot
of those things are, you know, you know,
we turn them social determinants of health, right?
Are, are sometimes beyond what we as clinicians
can immediately affect, uh, a change.
But I think just acknowledging the importance
of those things, uh, is, is critical.
Um, and I do think that there are these, um, you know,
people have termed it kind of, um,
not the social determinants of health,
but kind of the policy determinants of health.
I think those, those actually drive,
those actually drive our ability
or inability to address those.
I would say, um, you know, while we do want people, right,
not patients, but people to be more aware, engaged, um,
and, and, and, and active in, in,
in keeping themselves healthy.
And we know that a lot of that starts not, not in adulthood
or in late, you know, in middle age or, or or
or older age when people are actually sick.
But that starts like when they're adolescents
that starts when they're, you know, children.
It actually starts, you know, in the prenatal period, right?
We can't actually fix all that right now,
but I think one, one of the things we can, um, address is
how do we change behavior of physicians, of nurses,
of, um, healthcare leaders
and administrators so that we're all kind
of rowing in the same direction?
And, and, and you know, I think, Laura, you know,
I started out in private practice
and I, I had this very naive conception of healthcare.
Um, you know, coming from a, you know,
from an ac a busy academic medical center saying, Hey,
listen, if, you know, if I'm in practice on my own and,
and I'm not beholden to the rules of the medical center
or hospital, I'll be able to deliver the kind of care,
the kind of healthcare that I think is appropriate.
And boy, was that a rude awakening when I, you know, that,
you know, the first month in private practice when I
realized that, you know, the world
doesn't actually work that way.
Um, so I think, you know, in my journey through healthcare,
uh, through practice working in industry on a couple
of occasions, and then, um, you know, large, um, you know,
very, very, I think, uh,
forward thinking health systems like Cleveland Clinic
and Intermountain, it's really given me that perspective
that, that at the, at the end of the day, in order for us
to, to do better for our patients, to, to create
that awareness and, and that policy change, physicians have
to be front and center in, in,
in changing their own behavior
and recognizing what they need
to do in order to make that happen.
- That's great to hear it, and, you know, such a helpful
and important perspective
to have from the healthcare professional community.
Now, when you look ahead, what are you most excited about?
What makes you nervous?
- Well, you know, I'm excited about our, you know,
I think the growing, uh, not only awareness,
but the growing, uh, involvement that, that we as physicians
and we as healthcare providers have in
the whole value equation.
And, and I know that's, that, that's now kind
of a hackney term, right?
Value-based care. But,
but essentially, you know, if we're not able to leverage
a different model of payment, uh, a different reward system,
right, in, in healthcare, we won't be able to sustain
or motivate people to change.
So I'm excited by the fact that, you know, for example,
at Intermountain Health, we are, you know, 50% plus, uh, in,
uh, in value-based payment arrangements, which, you know,
it doesn't fix all
of those social determinants of health issues.
It doesn't fix all of the, um, the behavior change issues,
um, you know, for our providers
or for the people we care for,
but it gives us the opportunity to do so.
So that's what makes me really excited.
Um, but what makes me not excited is the fact that the, the,
the pace of change
and the amount of change, even for someone like me who's,
you know, really I, you know, I really try
to dedicate my career at, at changing healthcare delivery.
Um, it, it's dizzying.
So when, you know, when, for example,
the federal government has, oh, gosh, you know,
I think it's like 50 plus a different a CO or,
or alternative payment models as they used to be called, uh,
you know, the frontline clinician who, who,
who we really need to buy in and invest their time, effort
and, you know, you know, their, their blood sweat
and tears into, it's almost over.
It's almost over it, it's almost too overwhelming.
And then you've got a lot of noise, of course,
because, um, you know, you've got big players, uh, outside
of the traditional healthcare systems, you know, the Amazons
of the world, um, the, you know, the, the, the CVSs and,
and, and, you know, Walgreens, yes.
But now, no, you know,
that are really foreign into healthcare saying, Hey,
can we apply a lot of these things
that have been really successful in non-healthcare sectors
and make healthcare more efficient and effective?
Um, you know, I think there's been, I think the jury's out
because we've seen some great, um, success,
but we've also seen, um, some, some challenges.
And I think, I think where I, as a physician, um, you know,
become concerned is that, you know, with all the hype
and hyperbole around, you know, transforming healthcare and,
and disrupting healthcare, you know, who's really in it
for the long term, right?
Who's got the, who's got the will, uh,
or the finances to, to go
through the ebbs to get to the peak.
Does that make sense, Laura?
- Yeah, yeah, that makes a lot of sense.
You know, and it is a really fascinating way to approach,
um, just the healthcare landscape today,
because as you mentioned, you know,
it seems like there is huge opportunity from the traditional
healthcare space to figure out how
to do it better and, and deliver better.
But at the same time, there's so many complexities that,
you know, coming from outside of the industry and,
and trying to be successful within healthcare, um,
given the regulations, giving the just, um, how, you know,
important it is to communities and how necessary it is, um,
and everything else that goes along with the,
the broader healthcare ecosystem.
It's not easy to do
and just come into the industry, um, you know, brand new
and, and think you're going to make a big difference.
So, um, as you mentioned, we've seen that time
and time again from different entrants into the space,
and some have stuck around
and some have changed in, in some of,
you know, left to some degree.
And so when you look at the kind of broader space here,
who do you think is most best positioned?
Maybe not company by company,
although, you know, I would love to hear your thoughts on
that if you have thoughts,
but really in terms of, you know, um,
who within the healthcare
or non-healthcare space can really make the difference
that's needed in order to, um,
deliver better care, if that makes sense?
- Yeah, I, I, I think I, I think the thing
that's gonna be really critical, uh, and,
and part of this actually is shaped
by some recent conversations I've had with, um,
with physician leaders
and other folks, um, kind of internationally thinking about,
um, how they are approaching, um, you know, healthcare and,
and, you know, and disease prevention from
a societal standpoint.
You know, at the end of the day, you know, um, you,
you know, I think payers, um, I think health systems, um,
you know, uh, you know, individual, um, clinicians per, uh,
uh, you know, um, you know,
we all have a different stake in things.
But I think one of the things that I think will best, um,
align and ensure commitment, right?
Lasting commitment is like, how, what is the,
what is the population, right?
What is the constituency of, of, of interest?
Because, you know, I, I, now that I've worked, uh, you know,
uh, trying to, uh, negotiate contracts with payers, right?
But now as part of Intermountain, you know, we,
we have our own payer working inside that, that, um, that
that structure to, to kind
of see things from their perspective.
You know, I realize that it, it, it's
so much more complex than what, um, that that
what you see on the daily show, right?
Um, but, but what I do think is that, is there a way
that we can, um, activate, um, policy makers
and officials who have a, a lack, you know,
have a commitment to their community now beyond, and,
and again, and involve the communities in terms of
how they want to approach these things.
Because I, I think at the end of the day, um, you know, as,
as, as, as bullish I, as I've been in the past in, in terms
of, uh, participating in, you know,
in these new payment models
and whatnot, you know, these are kind of things
that are dictated by the length of a contract, right?
Maybe five years or so.
We really need to start thinking about
how do we integrate a sequence of these types
of contractual arrangements, connect the dots
so we have a more longitudinal, holistic view of
how we wanna approach health.
Um, and I, I think the big thing is, you know, obviously
until we stop, you know, until we stop the bleeding
or the, for these things like high cost hospitalizations,
readmissions, you know, preventable events like for example,
in the kidney space, people, um, you know, showing up and,
and the first time they see a kidney specialist is when
they, they start dialysis in the,
in the intensive care unit.
Those are things that if we can, we need
to eliminate those things.
'cause they are the low, low lowest hanging fruit,
although they're not easy to address.
But I think we need to work part
and par parcel with, you know, across a broad, um,
array of stakeholders.
So again, whether those are the leaders
of our health systems, people in industry, people who, who,
uh, are in public policy,
but also our, our, our, our,
you know, the people in the communities.
I think, I think ultimately healthcare, you know, we,
we keep hearing as a consumer driven industry, uh, I've yet
to actually see that consumers exercise their full
power in terms of influencing how we invest in,
in keeping them, keeping them healthy.
- That's such a great point.
And definitely, you know, fascinating to see how everything,
you know, will play out over the next few years.
And speaking of these changing market dynamics
and certainly, um, you know, where healthcare is headed,
what do you think, um,
most effective healthcare leaders will need in order
to be successful over the two to three years, um,
in the future, especially as I mentioned, thinking
through these changes in what really, um,
will make the biggest difference?
- Yeah, I, that, that's,
that's actually such a foundational question and, and,
and that ties this all together.
You know, Laura, um, earlier in my career, I, I, I was, um,
the VP of, of quality, um, at, uh, an indu for a, a company,
an industry in the, in the kidney health industry.
And, um, I, I, I really, really, um, learned so much about,
uh, about, uh, you know, Deming's teachings, quality,
you know, focus on the process, not the people.
But now as I, you know, 20 years later as I,
as I look back at, at, at what I've experienced,
and now looking at the landscape,
I think process is obviously really important.
We need to double down, triple down on the people, um,
the pandemic, as you know,
and I won't recapitulate what we know is, you know, put,
you know, it was really so, oh gosh, so, um, so harmful
to our, our caregivers, physicians, nurses, other,
other folks that are, you know, taking care of people,
you know, in, in the pandemic and whatnot.
And so now we are in this, um, you know, kind of,
I guess we're still, I guess we're post pandemic now,
but you know, the, the, the economics
and finances ha are are back front and center, and they're,
and they're making health systems, including Intermountain,
you know, have to make some really tough, you know, choices.
I, I think keeping our, our people whole, um,
and ensuring, um, not, not just,
not just having an initiative for employee wellness,
but truly looking at the near
and long-term needs of the people
that have dedicated their lives to healthcare.
That's what an effective leader needs to do.
'cause without the people, it's not gonna happen.
- Absolutely. I love that. Dr. Wong, thank you so much
for joining us on the podcast today.
This has been a fascinating discussion,
and I look forward to connecting with you again soon.
- Yeah, thank you, Laura. Again, thank you so much, uh,
to Beckers for inviting me to, uh, share my thoughts.