1 00:00:01,919 --> 00:00:04,500 This is where health care leadership comes together. 2 00:00:04,639 --> 00:00:07,759 Becker's sixteenth annual meeting brings more than 3,500 3 00:00:07,759 --> 00:00:10,880 hospital and health system executives and nearly 800 4 00:00:10,880 --> 00:00:14,259 speakers to Chicago, April 13 through the sixteenth. 5 00:00:14,714 --> 00:00:17,355 This year's event includes keynote conversations with Dallas 6 00:00:17,355 --> 00:00:20,315 Cowboys legend Troy Aikman and former president George 7 00:00:20,315 --> 00:00:22,954 w Bush. For the agenda and event details, 8 00:00:22,954 --> 00:00:25,275 visit beckershospitalreview.com 9 00:00:25,275 --> 00:00:26,875 and click on the events tab in the 10 00:00:26,875 --> 00:00:29,515 upper right. We're looking forward to hosting you 11 00:00:29,515 --> 00:00:30,335 in Chicago. 12 00:00:31,890 --> 00:00:34,210 Welcome to the Becker's Healthcare podcast. My name 13 00:00:34,210 --> 00:00:36,929 is Paige Twenter. I'm a reporter and assistant 14 00:00:36,929 --> 00:00:38,469 editor with Becker's Healthcare. 15 00:00:38,850 --> 00:00:40,929 I am so excited to be joined today 16 00:00:40,929 --> 00:00:43,969 by doctor Michael Weiss. Without further introduction, I 17 00:00:43,969 --> 00:00:44,770 would just love, 18 00:00:45,329 --> 00:00:47,145 you know, doctor Weiss, if you could tell 19 00:00:47,145 --> 00:00:48,905 us about yourself and a bit about your 20 00:00:48,905 --> 00:00:49,405 organization. 21 00:00:50,184 --> 00:00:51,704 Sure. Well, Paige, thank you, and thank you 22 00:00:51,704 --> 00:00:53,545 very much for having me today. I'm really 23 00:00:53,545 --> 00:00:55,304 excited to share some of the work that 24 00:00:55,304 --> 00:00:55,965 we're doing. 25 00:00:56,344 --> 00:00:58,045 Mike Weiss, I'm a general pediatrician, 26 00:00:59,310 --> 00:01:01,310 just a country doc. I practiced in the 27 00:01:01,310 --> 00:01:04,189 community for about twenty two years here in, 28 00:01:04,590 --> 00:01:05,489 Southern California 29 00:01:05,790 --> 00:01:06,530 in a 30 00:01:06,829 --> 00:01:09,150 private practice with a number of other physicians 31 00:01:09,150 --> 00:01:10,209 in general peds. 32 00:01:10,510 --> 00:01:12,209 And I always, was 33 00:01:12,784 --> 00:01:15,265 kind of excited about the system of health 34 00:01:15,265 --> 00:01:18,944 care and, how things could certainly be better 35 00:01:18,944 --> 00:01:19,844 than they are. 36 00:01:20,305 --> 00:01:22,064 I have a background with, 37 00:01:22,465 --> 00:01:25,284 having lost a brother and sister in childhood 38 00:01:25,424 --> 00:01:26,520 to congenital 39 00:01:27,140 --> 00:01:28,900 disease. And I grew up as a family 40 00:01:28,900 --> 00:01:29,400 member 41 00:01:29,859 --> 00:01:31,859 kind of observing this not only as a 42 00:01:31,859 --> 00:01:34,579 clinician, but more as a family member. And 43 00:01:34,579 --> 00:01:36,819 it just always was something that I wanted 44 00:01:36,819 --> 00:01:38,819 to do above and beyond seeing the patient 45 00:01:38,819 --> 00:01:41,204 in front of me. So, I, 46 00:01:41,525 --> 00:01:43,604 over the course of time, sought a little 47 00:01:43,604 --> 00:01:45,525 bit more education on the business side of 48 00:01:45,525 --> 00:01:46,025 medicine, 49 00:01:46,564 --> 00:01:49,284 and I was fortunate enough about eleven years 50 00:01:49,284 --> 00:01:50,504 ago to be, 51 00:01:51,444 --> 00:01:53,909 sought out by Children's Hospital of Orange County 52 00:01:54,209 --> 00:01:56,950 to start a population health division here. 53 00:01:57,890 --> 00:02:00,209 Lo and behold, here we are 11 later, 54 00:02:00,209 --> 00:02:02,289 and we've built something that I think is 55 00:02:02,289 --> 00:02:03,109 very exciting. 56 00:02:03,810 --> 00:02:05,810 In terms of our organization, it's been a 57 00:02:05,810 --> 00:02:06,950 very exciting year. 58 00:02:07,594 --> 00:02:10,235 Children's Hospital of Orange County, which, is where 59 00:02:10,235 --> 00:02:12,955 I was hired on to, actually merged with 60 00:02:12,955 --> 00:02:15,455 Rady Children's Hospital in San Diego 61 00:02:15,754 --> 00:02:18,955 to become Rady Children's Health, and that's now 62 00:02:18,955 --> 00:02:20,895 been one year since that merger. 63 00:02:21,579 --> 00:02:23,519 So we are represented by, 64 00:02:24,060 --> 00:02:26,400 three hospitals. We have, San Diego, 65 00:02:27,099 --> 00:02:29,340 Orange, and then we have a hospital in 66 00:02:29,340 --> 00:02:30,879 a hospital in Mission Viejo. 67 00:02:31,819 --> 00:02:33,919 And we have in both regions, 68 00:02:34,299 --> 00:02:35,519 we have subspecialty 69 00:02:36,555 --> 00:02:37,055 clinicians, 70 00:02:37,675 --> 00:02:41,615 tertiary quaternary services, and primary care networks. So 71 00:02:41,675 --> 00:02:44,395 it's actually a beautiful incubator to be working 72 00:02:44,395 --> 00:02:45,775 in this, field. 73 00:02:46,955 --> 00:02:48,715 You buried the lead, doctor Weiser. I didn't 74 00:02:48,715 --> 00:02:50,669 even mention the lead of you're the first 75 00:02:50,669 --> 00:02:52,610 ever endowed chair for wellness 76 00:02:53,069 --> 00:02:53,650 of Rady 77 00:02:54,030 --> 00:02:54,530 Children's. 78 00:02:54,830 --> 00:02:56,129 That was a recent appointment. 79 00:02:56,669 --> 00:02:58,509 Yeah. Well, it's always hard to blow your 80 00:02:58,509 --> 00:03:01,709 own horn, but, I'm I'm very, very honored 81 00:03:01,709 --> 00:03:04,590 that, the Clavis Foundation, which is a local 82 00:03:04,590 --> 00:03:05,090 foundation, 83 00:03:06,365 --> 00:03:07,985 have the forethought to 84 00:03:08,284 --> 00:03:08,685 really, 85 00:03:09,564 --> 00:03:12,444 look at wellness and prevention. And, I also 86 00:03:12,444 --> 00:03:15,004 give Rady Children's Health and and CHOC a 87 00:03:15,004 --> 00:03:17,344 lot of credit for really having the 88 00:03:18,280 --> 00:03:20,840 thought to think outside the the four walls 89 00:03:20,840 --> 00:03:21,580 of the hospital, 90 00:03:22,120 --> 00:03:23,259 and really consider 91 00:03:23,719 --> 00:03:27,080 that paradigm change of health care moving more 92 00:03:27,080 --> 00:03:28,620 into prevention and wellness. 93 00:03:29,239 --> 00:03:31,419 You know, we as clinicians and hospitals 94 00:03:31,879 --> 00:03:33,900 are very, very good at being reactive 95 00:03:35,104 --> 00:03:37,425 to, situations. You know, patient's sick, make an 96 00:03:37,425 --> 00:03:39,104 appointment, come see me. I'll take care of 97 00:03:39,104 --> 00:03:39,604 you. 98 00:03:39,905 --> 00:03:41,745 But the reality is when you look at 99 00:03:41,745 --> 00:03:42,485 the geography 100 00:03:43,185 --> 00:03:45,604 of, you know, these urban or suburban 101 00:03:45,985 --> 00:03:47,789 hospitals that we all work at, 102 00:03:48,349 --> 00:03:51,069 only five to 7% of the population ever 103 00:03:51,069 --> 00:03:52,049 really experiences 104 00:03:52,430 --> 00:03:54,430 the hospital, which is great. You know, we 105 00:03:54,430 --> 00:03:55,329 we love that. 106 00:03:56,109 --> 00:03:58,849 But where are the other 93 to 95%? 107 00:03:59,229 --> 00:04:00,924 These are kids that are at school, they're 108 00:04:00,924 --> 00:04:03,025 at the park, they're at faith based organizations, 109 00:04:03,405 --> 00:04:06,204 they're at, you know, all these, various community 110 00:04:06,204 --> 00:04:07,104 based organizations. 111 00:04:07,724 --> 00:04:08,224 And 112 00:04:08,525 --> 00:04:10,924 for us as a health care system, if 113 00:04:10,924 --> 00:04:13,025 we're not going out and proactively 114 00:04:13,484 --> 00:04:13,984 addressing, 115 00:04:14,939 --> 00:04:16,800 the causes of illness and, 116 00:04:17,740 --> 00:04:19,120 working with those communities, 117 00:04:19,819 --> 00:04:21,500 I don't feel like we're doing our job. 118 00:04:21,500 --> 00:04:25,020 So I I applaud Rady Children's Health, the 119 00:04:25,020 --> 00:04:26,000 Clavis Foundation, 120 00:04:26,675 --> 00:04:28,774 and I'm honored to be that first chair 121 00:04:28,915 --> 00:04:31,095 working toward that goal. Mhmm. 122 00:04:31,475 --> 00:04:34,194 On that note of prevention and meeting that 123 00:04:34,194 --> 00:04:35,014 ninety three, 124 00:04:35,714 --> 00:04:38,514 you know, percent of patients who aren't going 125 00:04:38,514 --> 00:04:40,295 to the hospital, what are 126 00:04:40,720 --> 00:04:42,800 really, like, two to three priorities you're setting 127 00:04:42,800 --> 00:04:44,500 for yourself in the next 128 00:04:45,040 --> 00:04:45,779 twelve months? 129 00:04:46,319 --> 00:04:48,579 Yeah. It's, it's definitely a, 130 00:04:49,439 --> 00:04:51,759 gonna be a bell shaped curve. There's gonna 131 00:04:51,759 --> 00:04:54,720 be, somewhat of an uphill battle because it's 132 00:04:54,720 --> 00:04:57,865 really a culture change. You As a pediatrician, 133 00:04:58,645 --> 00:05:01,205 I was I was trained to fix. I 134 00:05:01,205 --> 00:05:02,884 was trained bring me a problem, and I 135 00:05:02,884 --> 00:05:05,365 will fix it. I was not trained to 136 00:05:05,365 --> 00:05:07,064 prevent the problem from happening. 137 00:05:07,365 --> 00:05:09,769 And so I think priority number one is 138 00:05:09,769 --> 00:05:11,789 really going to be education and awareness. 139 00:05:12,169 --> 00:05:14,750 It's really working across the organization, 140 00:05:15,370 --> 00:05:17,470 primary care, specialty care, ancillaries, 141 00:05:17,849 --> 00:05:18,589 the community, 142 00:05:19,529 --> 00:05:20,029 leadership 143 00:05:20,584 --> 00:05:23,485 to get people to really understand the importance 144 00:05:23,545 --> 00:05:24,045 of, 145 00:05:24,504 --> 00:05:25,625 prevention and, 146 00:05:26,345 --> 00:05:27,485 and proactivity. 147 00:05:28,425 --> 00:05:30,904 You know, we've all seen some degree of 148 00:05:30,904 --> 00:05:34,105 the beautiful slide that shows that 80% of 149 00:05:34,105 --> 00:05:35,324 what makes us healthy, 150 00:05:35,879 --> 00:05:38,040 has nothing to do with what doctors and 151 00:05:38,040 --> 00:05:41,660 hospitals do. It's your genetics. It's your environment. 152 00:05:41,720 --> 00:05:44,600 It's the exposures you have. It's it's all 153 00:05:44,600 --> 00:05:47,160 those things. And if we're not addressing those, 154 00:05:47,160 --> 00:05:50,060 we're not addressing the major reasons why, 155 00:05:50,824 --> 00:05:51,725 illness occurs, 156 00:05:52,105 --> 00:05:54,504 the social drivers of health, etcetera. So I 157 00:05:54,504 --> 00:05:57,305 think that's that's priority number one. I think 158 00:05:57,305 --> 00:05:58,685 priority number two 159 00:05:59,145 --> 00:06:01,865 is that I want to be sure as 160 00:06:01,865 --> 00:06:03,564 we enter into this arena 161 00:06:04,310 --> 00:06:06,550 that we do it in an evidence based 162 00:06:06,550 --> 00:06:10,870 fashion. So certainly things like integrative medicine are 163 00:06:10,870 --> 00:06:12,889 something that the public really wants. 164 00:06:13,589 --> 00:06:15,610 And I can tell you that the clinical 165 00:06:15,750 --> 00:06:17,370 side is very skeptical. 166 00:06:17,774 --> 00:06:20,595 And so bringing those two areas together, 167 00:06:21,774 --> 00:06:24,014 studying it in an appropriate manner, 168 00:06:24,894 --> 00:06:28,115 and assuring that it's, evidence based, 169 00:06:28,495 --> 00:06:31,339 is another huge priority that I have. I 170 00:06:31,339 --> 00:06:33,579 always look back to, you know, people are 171 00:06:33,579 --> 00:06:35,500 probably aware if they're of my generation of 172 00:06:35,500 --> 00:06:37,980 the Framingham study, which is a study that 173 00:06:37,980 --> 00:06:38,959 was done in Massachusetts 174 00:06:39,579 --> 00:06:40,079 ongoing 175 00:06:40,459 --> 00:06:42,379 that has looked now for fifty or sixty 176 00:06:42,379 --> 00:06:44,605 years at a cohort of people that were 177 00:06:44,605 --> 00:06:47,884 born, and they followed numerous markers on those 178 00:06:47,884 --> 00:06:48,384 patients, 179 00:06:49,084 --> 00:06:51,404 looking all the way from blood work to 180 00:06:51,404 --> 00:06:54,944 social drivers, to genetics, to their employment, etcetera, 181 00:06:55,004 --> 00:06:57,404 etcetera, to determine what it is that really 182 00:06:57,404 --> 00:06:58,290 drives health. 183 00:06:58,610 --> 00:07:00,850 Well, I would love to really do something 184 00:07:00,850 --> 00:07:03,029 like that on the pediatric side 185 00:07:03,330 --> 00:07:05,509 to really look at what are the interventions 186 00:07:05,649 --> 00:07:06,470 that we can, 187 00:07:07,250 --> 00:07:07,750 consider 188 00:07:08,290 --> 00:07:09,509 that may ultimately 189 00:07:10,464 --> 00:07:13,904 lead to better longevity, better outcomes in children? 190 00:07:13,904 --> 00:07:16,064 You know, for instance, a family who has 191 00:07:16,064 --> 00:07:16,725 a baby, 192 00:07:17,425 --> 00:07:19,664 and the family has a strong history of 193 00:07:19,664 --> 00:07:21,764 cancer or diabetes or rheumatologic 194 00:07:22,225 --> 00:07:22,725 condition. 195 00:07:23,185 --> 00:07:25,444 Are there interventions that we can undertake 196 00:07:26,220 --> 00:07:28,080 before those things manifest 197 00:07:28,540 --> 00:07:31,120 that can perhaps prevent them or prolong 198 00:07:31,740 --> 00:07:33,180 the onset of those, 199 00:07:33,660 --> 00:07:36,939 those conditions? So that's another paradigm change that 200 00:07:36,939 --> 00:07:39,745 I think, would be really important. And, again, 201 00:07:39,745 --> 00:07:41,824 doing it in an evidence based way so 202 00:07:41,824 --> 00:07:44,225 that we can study it and publish those 203 00:07:44,225 --> 00:07:47,185 studies and try to drive change, in terms 204 00:07:47,185 --> 00:07:48,645 of how we practice medicine. 205 00:07:49,585 --> 00:07:50,884 Mhmm. But the 206 00:07:51,264 --> 00:07:52,645 fifty year Framingham 207 00:07:53,185 --> 00:07:54,564 study, are you imagining 208 00:07:55,209 --> 00:07:58,089 or wanting to kind of start, like, a 209 00:07:58,089 --> 00:07:59,069 decades long 210 00:07:59,370 --> 00:08:00,750 research project then? 211 00:08:01,209 --> 00:08:03,289 I would love to. You know, I've spoken 212 00:08:03,289 --> 00:08:05,930 with our research department here, and we have 213 00:08:05,930 --> 00:08:07,229 some NIH, 214 00:08:07,849 --> 00:08:08,349 grant 215 00:08:08,665 --> 00:08:11,464 recipient researchers here, r one, r two grants, 216 00:08:11,464 --> 00:08:12,764 which are the the big 217 00:08:13,305 --> 00:08:13,964 NIH grants. 218 00:08:15,225 --> 00:08:17,545 And they seem very excited about what I've 219 00:08:17,545 --> 00:08:18,045 described. 220 00:08:18,665 --> 00:08:20,584 So I think if we can outline something 221 00:08:20,584 --> 00:08:21,725 like that and 222 00:08:22,169 --> 00:08:25,529 perhaps draw out a multi decade approach to 223 00:08:25,529 --> 00:08:26,029 this, 224 00:08:26,490 --> 00:08:28,110 it would be very, very exciting. 225 00:08:28,649 --> 00:08:30,829 Mhmm. I'd also love to know more about 226 00:08:31,370 --> 00:08:33,049 I mean, you you know, I asked for 227 00:08:33,049 --> 00:08:34,649 your priorities and you gave me priorities. I'd 228 00:08:34,649 --> 00:08:36,269 love to know more about kinda, like, 229 00:08:36,965 --> 00:08:38,345 your personal investment 230 00:08:38,884 --> 00:08:39,865 in this. You mentioned, 231 00:08:40,644 --> 00:08:43,685 earlier, your family background and losing your brother 232 00:08:43,685 --> 00:08:44,345 and sister 233 00:08:44,725 --> 00:08:45,625 really fueled 234 00:08:46,085 --> 00:08:46,585 your 235 00:08:47,045 --> 00:08:50,070 interest in, you know, working for, I believe 236 00:08:50,070 --> 00:08:52,149 you said, twenty two years in health care. 237 00:08:52,149 --> 00:08:52,970 Can you share 238 00:08:53,430 --> 00:08:54,410 more about that? 239 00:08:55,029 --> 00:08:56,790 Yeah. I mean, you know, I'm I'm forty 240 00:08:56,790 --> 00:08:58,570 years in now of being a pediatrician 241 00:08:59,350 --> 00:09:01,910 and, twenty two in private practice. And then 242 00:09:01,910 --> 00:09:03,210 I did a a stint 243 00:09:03,565 --> 00:09:05,725 kind of learning the business side actually on 244 00:09:05,725 --> 00:09:06,705 the adult side, 245 00:09:07,485 --> 00:09:10,305 in the, in the, insurance side. 246 00:09:11,325 --> 00:09:12,945 But I I think, you know, 247 00:09:13,404 --> 00:09:13,904 medicine 248 00:09:14,285 --> 00:09:17,899 is a very interesting thing. It's it's probably 249 00:09:17,899 --> 00:09:19,740 the only business that runs the way it 250 00:09:19,740 --> 00:09:21,200 runs and is still in business, 251 00:09:22,139 --> 00:09:24,959 because of the way that we approach it. 252 00:09:25,500 --> 00:09:27,740 And we all talk about, you know, value 253 00:09:27,740 --> 00:09:30,299 based payment, and we talk about universal health 254 00:09:30,299 --> 00:09:31,924 care, all of this. And, you know, again, 255 00:09:31,924 --> 00:09:33,445 I've been doing this for forty years. And 256 00:09:33,445 --> 00:09:35,365 I think thirty years ago, I started first 257 00:09:35,365 --> 00:09:38,404 hearing value based payments coming, it's coming, it's 258 00:09:38,404 --> 00:09:40,164 coming, you know, and here we are thirty 259 00:09:40,164 --> 00:09:42,164 years later, and there are pockets of it. 260 00:09:42,164 --> 00:09:44,964 You know, we in Southern California and we're 261 00:09:45,125 --> 00:09:46,264 I know we're a unicorn, 262 00:09:46,850 --> 00:09:49,009 but, you know, I I oversee a group 263 00:09:49,009 --> 00:09:50,529 of a 140,000 264 00:09:50,529 --> 00:09:51,750 Medicaid children 265 00:09:52,050 --> 00:09:53,830 who are under global capitation 266 00:09:54,529 --> 00:09:57,190 and have been so for almost thirty years. 267 00:09:57,410 --> 00:10:00,144 And we've made that work for thirty years. 268 00:10:00,365 --> 00:10:02,445 Our doctors are happy. The patients are getting 269 00:10:02,445 --> 00:10:05,245 great care, and the system works. But I 270 00:10:05,245 --> 00:10:08,225 understand that the vast majority of the country 271 00:10:08,445 --> 00:10:10,945 is still in a fee for service paradigm. 272 00:10:11,500 --> 00:10:12,879 And it's very challenging, 273 00:10:13,420 --> 00:10:15,820 to achieve some of these things in a 274 00:10:15,820 --> 00:10:17,920 fee for service paradigm. There's no, 275 00:10:18,460 --> 00:10:19,519 payment reimbursement 276 00:10:19,980 --> 00:10:20,480 reward 277 00:10:20,860 --> 00:10:24,540 for preventative care, for counseling, for team based 278 00:10:24,540 --> 00:10:25,040 care. 279 00:10:25,740 --> 00:10:27,200 There are pockets of 280 00:10:27,554 --> 00:10:30,115 demonstration projects. You know, CMMI has done a 281 00:10:30,115 --> 00:10:31,794 number of things, and, you know, I give 282 00:10:31,794 --> 00:10:32,615 them credit. 283 00:10:33,794 --> 00:10:36,034 But we're still in this do one, get 284 00:10:36,034 --> 00:10:38,054 paid, do two, get paid twice 285 00:10:38,595 --> 00:10:42,629 world. And until we change that paradigm, it's 286 00:10:42,629 --> 00:10:44,889 going to be a big challenge for 287 00:10:45,429 --> 00:10:47,450 us to move into this preventative 288 00:10:48,070 --> 00:10:49,210 proactive care, 289 00:10:49,669 --> 00:10:50,169 model. 290 00:10:51,029 --> 00:10:53,529 You mentioned paradigm shifts, with 291 00:10:54,144 --> 00:10:56,964 your or an uphill battle with culture changes, 292 00:10:57,345 --> 00:10:59,664 related to integrative medicine. And then, of course, 293 00:10:59,664 --> 00:11:00,964 paradigm shifts 294 00:11:01,264 --> 00:11:02,964 are really a true 295 00:11:03,345 --> 00:11:03,845 adoption, 296 00:11:04,464 --> 00:11:07,690 and rollout of VBC. Whereas right now it's 297 00:11:07,690 --> 00:11:09,690 just in pockets and will likely just be 298 00:11:09,690 --> 00:11:10,669 in pockets for 299 00:11:11,370 --> 00:11:12,429 many more years. 300 00:11:13,049 --> 00:11:14,350 I'm curious on 301 00:11:14,730 --> 00:11:15,230 actionable 302 00:11:15,850 --> 00:11:17,389 tips, like, for our listeners 303 00:11:18,009 --> 00:11:20,384 if they're interested in, you know, having their 304 00:11:20,384 --> 00:11:23,524 own unicorn of, you know, 140,000 305 00:11:23,745 --> 00:11:25,285 children, VBC model, 306 00:11:25,665 --> 00:11:27,685 what first steps would you recommend? 307 00:11:28,705 --> 00:11:30,945 Well, I think you have to start with 308 00:11:30,945 --> 00:11:33,419 leadership buy in. You know, as much as 309 00:11:33,419 --> 00:11:35,259 I hate to admit it, in my forty 310 00:11:35,259 --> 00:11:36,639 years, I've come, 311 00:11:37,500 --> 00:11:39,759 full circle and I am semi tainted. 312 00:11:40,379 --> 00:11:42,379 Health care is a business, and it is 313 00:11:42,379 --> 00:11:43,519 all about the money. 314 00:11:43,899 --> 00:11:46,159 And, as much as we as physicians 315 00:11:46,779 --> 00:11:48,315 want it to be all about the quality 316 00:11:48,315 --> 00:11:50,475 of care, you know, certainly that's there, and 317 00:11:50,475 --> 00:11:52,634 and we're doing our very, very best. But 318 00:11:52,634 --> 00:11:53,294 the reality 319 00:11:54,075 --> 00:11:56,235 is it it really comes down to making 320 00:11:56,235 --> 00:11:58,394 it work financially. And I get it. You 321 00:11:58,394 --> 00:12:00,649 know, I I have spent my career trying 322 00:12:00,649 --> 00:12:02,970 to understand the business side and the clinical 323 00:12:02,970 --> 00:12:05,129 side and marrying the two so that they 324 00:12:05,129 --> 00:12:06,649 don't kill each other and we can get 325 00:12:06,649 --> 00:12:07,389 things done. 326 00:12:08,490 --> 00:12:10,330 But I I think that the number one 327 00:12:10,330 --> 00:12:11,950 thing is it's gotta be a leadership 328 00:12:12,674 --> 00:12:15,315 cultural belief. You have to have the c 329 00:12:15,315 --> 00:12:15,815 suite 330 00:12:16,355 --> 00:12:17,575 believing and understanding 331 00:12:18,195 --> 00:12:21,075 that value based care can work clinically and 332 00:12:21,075 --> 00:12:24,115 financially. And there's plenty of, again, pockets of 333 00:12:24,115 --> 00:12:26,929 unicorns that, are doing this. There's great work 334 00:12:26,929 --> 00:12:30,389 in Massachusetts. There's great work in in Pennsylvania. 335 00:12:30,690 --> 00:12:32,789 There's great work in Seattle, Washington, 336 00:12:33,329 --> 00:12:34,149 in California. 337 00:12:34,610 --> 00:12:36,950 But, again, this starts at the very top. 338 00:12:37,409 --> 00:12:38,850 The second piece of it is you have 339 00:12:38,850 --> 00:12:40,789 to have a payer that believes in it. 340 00:12:41,144 --> 00:12:42,365 And the payers, 341 00:12:42,745 --> 00:12:45,165 you know, are in a very difficult position 342 00:12:45,225 --> 00:12:46,904 because their number one goal is they have 343 00:12:46,904 --> 00:12:47,725 to sell product. 344 00:12:48,105 --> 00:12:51,245 And they sell product based upon the attractiveness 345 00:12:51,865 --> 00:12:52,845 of their 346 00:12:53,659 --> 00:12:56,059 outcomes and their and their programs. And I 347 00:12:56,059 --> 00:12:58,639 think that there are enough studies demonstrating 348 00:12:59,339 --> 00:13:02,299 the outcomes and the attractiveness, I'm holding my 349 00:13:02,299 --> 00:13:04,319 hands up in air quotes for those listening, 350 00:13:05,100 --> 00:13:06,159 of these programs, 351 00:13:07,004 --> 00:13:09,485 to make it attractive enough to invest in 352 00:13:09,485 --> 00:13:09,985 that. 353 00:13:10,365 --> 00:13:12,045 A great example is there is a health 354 00:13:12,045 --> 00:13:13,985 plan, I won't name it, on the podcast, 355 00:13:14,285 --> 00:13:16,285 who invests in a special needs, 356 00:13:16,684 --> 00:13:17,184 program. 357 00:13:17,565 --> 00:13:20,649 They actually pay various medical groups. We are 358 00:13:20,649 --> 00:13:21,470 one of them, 359 00:13:21,929 --> 00:13:24,889 a proactive fee to care manage their highest 360 00:13:24,889 --> 00:13:25,709 risk patients. 361 00:13:26,169 --> 00:13:28,409 And what has been shown in that program 362 00:13:28,409 --> 00:13:29,549 is that by putting, 363 00:13:30,250 --> 00:13:33,470 a care team around these highest risk patients, 364 00:13:33,925 --> 00:13:38,264 including case management, social services, navigation systems, etcetera, 365 00:13:38,884 --> 00:13:41,764 you can reduce the ED visits. You can 366 00:13:41,764 --> 00:13:42,904 reduce the readmissions 367 00:13:43,285 --> 00:13:45,764 and thus reduce the cost of care while 368 00:13:45,764 --> 00:13:48,805 maintaining or improving the quality of care. So 369 00:13:48,805 --> 00:13:51,029 it works. It's just a matter of getting 370 00:13:51,029 --> 00:13:54,730 the c suite and the health plans together 371 00:13:55,029 --> 00:13:56,490 to understand that it works. 372 00:13:57,429 --> 00:13:59,110 Unfortunately, we only have a few more minutes. 373 00:13:59,110 --> 00:14:01,269 I could talk forever with you. But, we 374 00:14:01,269 --> 00:14:03,674 unfortunately have a few minutes left of our 375 00:14:03,674 --> 00:14:05,995 podcast today. And last question for you, doctor 376 00:14:05,995 --> 00:14:06,495 Weiss, 377 00:14:07,355 --> 00:14:09,455 is where do you see the biggest opportunities 378 00:14:09,995 --> 00:14:12,414 for growth in the next year? 379 00:14:13,514 --> 00:14:16,014 Yeah. You know, I I really think that 380 00:14:16,399 --> 00:14:19,539 the movement for what's called advanced primary care, 381 00:14:20,160 --> 00:14:21,620 is is very important. 382 00:14:22,320 --> 00:14:24,820 You know, primary care right now, 383 00:14:25,440 --> 00:14:26,960 and I can say this because I did 384 00:14:26,960 --> 00:14:29,519 it for twenty two years, feels like a 385 00:14:29,519 --> 00:14:30,419 hamster wheel, 386 00:14:31,144 --> 00:14:33,625 particularly in pediatrics. You know, we have what 387 00:14:33,625 --> 00:14:35,865 are called the bright futures recommendations from the 388 00:14:35,865 --> 00:14:38,665 American Academy of Pediatrics and, you know, all 389 00:14:38,665 --> 00:14:42,504 the current issues aside with vaccine refusal and, 390 00:14:42,504 --> 00:14:44,425 you know, all those types of things. You 391 00:14:44,425 --> 00:14:47,350 know, we are given ten to fifteen minutes 392 00:14:47,350 --> 00:14:49,509 to see a child, and there are 15 393 00:14:49,509 --> 00:14:51,190 or 20 things that we need to do 394 00:14:51,190 --> 00:14:55,210 in that visit, including anticipatory guidance, including immunizations, 395 00:14:55,429 --> 00:14:56,970 including the physical exam, 396 00:14:57,350 --> 00:14:59,929 including preventative care, you know, etcetera, etcetera. 397 00:15:00,945 --> 00:15:03,264 I I think advanced primary care really is 398 00:15:03,264 --> 00:15:05,665 the future where we are able to more 399 00:15:05,665 --> 00:15:06,165 effectively 400 00:15:06,545 --> 00:15:07,045 embed 401 00:15:07,424 --> 00:15:08,325 mental health, 402 00:15:08,705 --> 00:15:09,684 social services, 403 00:15:10,785 --> 00:15:12,165 community health workers, 404 00:15:12,865 --> 00:15:14,245 a number of different roles, 405 00:15:14,625 --> 00:15:15,445 health coaches 406 00:15:16,079 --> 00:15:19,120 into a primary care where the physician or 407 00:15:19,120 --> 00:15:19,620 APP 408 00:15:20,319 --> 00:15:23,199 is able to do their job and have 409 00:15:23,199 --> 00:15:26,259 these wraparound services that are reimbursed, 410 00:15:27,519 --> 00:15:27,745 to provide all those other services that we 411 00:15:27,745 --> 00:15:27,830 know make up 80% of what health is. 412 00:15:27,830 --> 00:15:28,419 So I think 413 00:15:40,565 --> 00:15:42,899 positive out of that is that the major 414 00:15:42,899 --> 00:15:44,039 issue with subspecialties 415 00:15:44,340 --> 00:15:45,720 these days is they're overwhelmed, 416 00:15:46,100 --> 00:15:48,580 and I get it. It's very challenging, and 417 00:15:48,580 --> 00:15:52,200 a significant percentage of what's referred to subspecialty 418 00:15:52,500 --> 00:15:55,620 care is not appropriate for subspecialty care, could 419 00:15:55,620 --> 00:15:57,615 be cared for in a primary care office. 420 00:15:57,774 --> 00:15:59,455 And a lot of times, it's not able 421 00:15:59,455 --> 00:16:02,115 to be done because of time, simply time. 422 00:16:02,334 --> 00:16:04,095 And so I think we can make both 423 00:16:04,095 --> 00:16:07,615 sides of that equation work by really looking 424 00:16:07,615 --> 00:16:11,375 toward funding and supporting an advanced primary care 425 00:16:11,375 --> 00:16:11,875 model. 426 00:16:12,720 --> 00:16:14,080 Well, thank you so much, doctor Weiss, and 427 00:16:14,080 --> 00:16:16,019 I'm excited to hear updates 428 00:16:16,399 --> 00:16:16,899 on, 429 00:16:17,440 --> 00:16:18,980 advanced primary care models. 430 00:16:19,279 --> 00:16:21,519 Yeah. Thank you. I really, really appreciate your 431 00:16:21,519 --> 00:16:24,000 time today, doctor Weiss. My pleasure, Paige. Thank 432 00:16:24,000 --> 00:16:25,273 you very much for having me.