Healthcare is Hard: A Podcast for Insiders

In the first of a series of episodes exploring opportunities for innovation in the pharmacy space, Mark Cuban offered perspective from an outsider intent on disrupting the status quo. In this, the second episode, Dr. Troyen Brennan gives an insider point-of-view from someone who has studied and worked in the space for decades.

Dr. Brennan was Chief Medical Officer at CVS Health for nearly 14 years, and before that, Chief Medical Officer at Aetna for two years. He was also a practicing physician at Brigham and Women’s Hospital for 15 years where he was president of Brigham and Women’s Physician Organization. During that time, he was also Professor of Medicine at Harvard Medical School and Professor of Law and Public Health at the Harvard T.H. Chan School of Public Health. He is the former Chair of the American Board of Internal Medicine and has published six books and more than 600 articles offering his insight into the American healthcare system, and his ideas on how to improve it.

With extensive knowledge of how the industry has evolved, and an understanding for why many of the complexities in the industry exist, Dr. Brennan offers a unique viewpoint about where and how disruption in the pharmacy space can succeed. In his eyes, the idea of good and bad actors in the pharmacy space is a false narrative. With an historical perspective, he explains how industry processes were all sensible when they were first implemented, and how that viewpoint is critical to understanding and addressing some that may have become seemingly senseless over time.

A few of the topics he discussed with Keith Figlioli in this Healthcare is Hard episode include:

• Six ways PBMs have lowered cost. Dr. Brennan provides a history of pharmacy benefits managers (PBMs), why they were created in the late 1950s and how they have helped the pharmacy industry. He discussed his thoughts on the six things PBMs have done – and are still doing – to help control costs. These include expanding the use of mail order pharmacies, sourcing generic drugs, introducing tiered pricing, implementing prior authorization and utilization management, assembling pharmacy networks, and negotiating rebates.
• Flexibility of PBMs. When discussing the future role PBMs may or may not play in the industry, Dr. Brennan says he’s confident in the ability for big PBMs to adapt. He believes they’ve proven to be more flexible than other parts of the healthcare system and will continue to have significant influence as regulations evolve and disruptors enter the market. He says that Mark Cuban is having a good influence on the industry overall with Cost Plus Drug Company, but would bet on the ability of PBMs to adapt.
• The path to greater affordability. With new, life-changing therapeutics being introduced regularly and specialty pharmacy expected to become a significant portion of healthcare spending, Dr. Brennan discusses some of the potential options for ensuring these treatments are affordable. He believes entrepreneurs disrupting the space can help contribute, but regardless of the role they play, says government will ultimately have to step in with price controls. He points to the role government plays controlling the costs of hospital services and says it will eventually have to play a similar role in the pharmacy space.

To hear Dr. Brennan and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Mark Cuban built a career disrupting industries and creating new ones. Now, his sights are set on healthcare.

There’s no secret ingredient to Mark’s success. As the world sees very publicly on Shark Tank, his style is the opposite of keeping secrets. It’s based on providing respectful, but direct, honest and unvarnished opinions. He’s bringing that style to healthcare in order to inject what he says the industry is lacking most. Trust.

To kick-off a series of Healthcare is Hard podcast episodes that will dive deep into all aspects of reinventing the pharmacy space, Keith Figlioli sat down with Mark to discuss his vision and strategy behind Mark Cuban Cost Plus Drug Company, and many other healthcare-related topics.

With Cost Plus Drug Company, Mark is bringing radical transparency to what he says is the most opaque industry he’s ever been involved in. He’s doing it by pricing every single product the same way – the cost of a drug, plus 15% markup, plus pharmacy fee (if any), plus shipping – and publishing these details for everyone to see.

Through this model, Mark aims reduce costs and improve access to drugs, while rebuilding trust in the industry. With 2,400+ drugs now available, he’s off to a fast start and talked to Keith about other evolving elements of the business including wholesale operations for providers, partnerships with grocery and pharmacy chains, and more.

Some of the other topics Keith and Mark discussed include:

• The Netflix model for specialty drugs. With revolutionary precision medicine coming to market at high costs that can reach millions of dollars per treatment, how will employers and consumers afford them? According to Mark, that’s the wrong question. He’s looking at the challenge through the manufacturer’s lens, asking how much they’ve invested in drug development and at what dollar value can they make reasonable returns. He discussed conversations he’s having with manufacturers about creating subscription services that could cover a wide range of high-cost, specialty drugs.
• Transparent, direct contracting. Mark now self-insures his employees and their family members, contracts directly with providers on payment rates, and – following the Cost Plus philosophy – publishes everything for the world to see. He shared a personal story that helped lead him to this decision where he paid a provider directly when his son needed an X-ray and realized it was a fraction of the cost of agreed upon rates with his insurance company. He talked about how this decision cuts other costs while improving employee wellness, removing burdens on HR, and ultimately helping providers by removing the risk they take and helping them get paid faster.
• Millions of AI models. Mark is a big believer that there will be millions of AI models and everyone will have one. He says 100 years from now you’ll be able to ask him questions through a model trained on all his emails and data. But AI in healthcare will be more segmented. He talks about how there’s no way leading research hospitals with respected brands will feed their data into one large language model unless they get paid an extreme amount of money. They may even stop publishing “anything and everything” to prevent their research from being ingested into someone else’s model.

To hear Mark and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

In most industries, innovation leads to an improved product or service while ultimately helping to lower cost. Healthcare is the exception. Despite a constant pursuit of new science, technology, operational efficiencies, business models and more, healthcare expenditures in the U.S. have continued to increase for decades with little sign of bending the cost curve downward.

What causes this phenomenon in U.S. healthcare, and what can we do about it? In their book, Why Not Better and Cheaper?: Healthcare and Innovation, twin brothers James B. Rebitzer and Robert S. Rebitzer offer answers to those questions.

Jim and Bob’s book brings together research on incentives, social norms, and market competition to argue that the healthcare system generates the wrong kinds of innovation. They contend that U.S. healthcare makes it too easy to profit from low-value innovations and too hard to profit from innovations that reduce the costs of care. As a result, we get a system where innovation abounds, but finding ways to deliver increased value at lower cost is remarkably ineffective.

In this episode of Healthcare is Hard, Keith Figlioli talked to Jim, a professor at Boston University’s School of Business, and Bob, National Advisor at Manatt Health, for an in-depth discussion about their work. Their conversation explored topics including:

• Misaligned incentives. Understanding how incentives work inside and between organizations has been a large focus of Jim’s career in economics, and he now applies that work to the complex world of healthcare. As an example of that complexity that’s all too common, Bob shared a story of a scientist and entrepreneur he advised who had developed a quick and inexpensive way to change how people walk in order to reduce pressure on the knee. While this could defer or obviate the need for common and expensive knee replacement surgeries, he discussed how difficult it would be to turn this idea into a profitable business since organizations across the healthcare ecosystem lack proper incentives to pay for it. He discussed why gain sharing would be the solution in every other part of the economy, and why it doesn’t work in healthcare.
• The fourth vital sign of healthcare. People generally think of the healthcare system as having three vital signs – cost, quality and access. But Jim and Bob see a fourth vital sign that, so far, hasn’t been recognized. In the long sweep of history, they say innovation matters just as much as the other three vital signs and stress that part of a healthy system should be the ability to produce innovations that increase value to patients while lowering costs.
• Innovation vs. irrational finance. In order to truly unlock innovation does the country’s irrational finance and insurance system need to be fixed first? Bob and Jim share their thinking around this debate and their ultimate conclusion: not necessarily. Bob compares healthcare innovation to walking uphill in a fog… you never know when you’re going to reach the top, but all you can do is place your foot in a somewhat higher place than it was before.

To hear Keith, Bob and Jim discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Through its work with more than 41,000 healthcare facilities and the industry’s largest database of patient feedback, Press Ganey gives organizations the data and insights they need to put the human experience at the center of healthcare.

Since it was founded nearly 40 years ago by Professors Press and Ganey at the University of Notre Dame, the company has built a reputation for being the prominent source of patient feedback, but it hasn’t stopped there. Its solutions capture the voice of the patient, physician, nurse, and employee to keep healthcare focused on people by enabling organizations to address safety, clinical excellence, patient and member experience, and workforce engagement.

Pat Ryan became CEO of Press Ganey in 2012 after more than 30 years working with healthcare leaders and providers, including a dozen years as a Press Ganey client. Pat has served on several health system boards and has worked throughout his career to improve the quality and safety of care while lowering cost and achieving caregiver resilience to deliver truly patient-centered experience.

In this episode of Healthcare is Hard, Pat spoke with Keith Figlioli about the increasing focus on human experience in healthcare transformation. Drawing knowledge from his career and from Press Ganey’s unrivaled understanding of patients and the professionals who serve them, Pat shared his perspective on topics including:

• The link between patient experience and financial success. Pat shared what he says is a little known fact – that health systems across the country with the highest margins also have the highest patient scores. He talked about how the two are linked and how value leads to long term community loyalty. He cited his time on the board of Beth Israel Deaconess Medical Center where they looked at patient data first and financial data second. He says health systems today need a comprehensive view that also includes safety and employee engagement data in order to identify opportunities for improvement.
• Redesigning healthcare from the outside in. Any consumer business would start with the needs of the customer first and work backwards to design systems that add value. But healthcare wasn’t created that way and was built from the inside-out. Pat discussed the need for healthcare organizations to continue the long journey of recognizing that consumers comes first, and talked about how workforce engagement will be an important component of that as the industry evolves.
• The trust factor. Pat describes how organization can map trust in order to understand where it breaks down by identifying friction points within the customer journey. He talks about how important it is to build and maintain trust in all relationships – not just a patient or family’s trust in an organization, but also nurse, clinician and employee trust in their organization and leadership. He mentions how important this is for payer organizations that are especially susceptible to unfair or inaccurate perceptions.
• Opportunities for innovation. When discussing areas where healthcare organizations can improve, and where innovators in the space can help them, Pat’s focus during this conversation was mostly on two issues – home care and the shift towards value. He says figuring out how to care for more people at home is going to be critical and sees opportunity around redesigning the healthcare workforce for the gig economy. He also talks about how slow the movement to value-based contracts has been and how a major break in the system may finally force congress to act if adoption doesn’t pick up.

To hear Keith and Pat discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

This is the final episode in a four part series with heads of strategy at providers and payers from across the healthcare ecosystem to explore “the new normal” in a post-COVID operating environment. For this episode Keith Figlioli welcomed Sukanya Soderland, Chief Strategy Officer at Blue Cross Blue Shield of Massachusetts, to explore how a regional payer is adapting. This follows previous episodes that offered a diverse perspective from heads of strategy at:

• A regional health system, OhioHealth (Episode 58)
• A national health system, CommonSpirit Health (Episode 59)
• A national payvider, Humana (Episode 60)

To wrap up this series, Sukanya provides a glimpse into the strategy at BCBS MA, the largest health plan in Massachusetts and a mostly commercial-focused payer that serves nearly three million members across New England. Unlike most not-for-profit organizations, BCBS MA pays significant federal, state, and local taxes and assessments. Without soliciting or receiving charitable donations, or benefiting from tax-exempt financing, BCBS MA stays competitive by generating a small margin from operations that it reinvests in its business, people, and technology, and by remaining deeply focuses on the community its serves.

In her discussion with Keith, Sukanya shared her outlook on issues including:

• Shared empathy between operations and innovation. For any head of strategy, serving the immediate needs of an organization is equally as important as anticipating and planning for future demands and market forces. Sukanya discussed how business leaders can sometimes view innovation leaders as out of touch with current realities, while innovation leaders might view business leaders as “dinosaurs.” She talked about the importance of developing a culture of empathy and trust between these groups.
• Building vs. buying vs. co-designing. To stay competitive against larger, national organizations, regional payers must recognize what they do well and where they should partner with other like-minded entities to augment their capabilities. Sukanya talked about making decisions to partner or co-develop capabilities with others, including sister companies across the Blue Cross Blue Shield Association, as a way of advancing sustainable, non-profit healthcare. She also recognized the challenges with driving meaningful change in affordability, quality and consumer experience without being intimately involved in care delivery, and discussed creative ways of partnering with incumbent health systems or new and innovative care delivery models to make that happen.
• Changing dynamics in how people access care. One of the biggest changes Sukanya sees occurring over the next decade is the way people access care. She discussed several of the market factors driving this change from the supply and demand of primary care physicians, to Generation Z aging into adulthood. She talked about how healthcare is losing the “quarterback” function as young adults turn to social media, trusted contacts and convenience in place of a strong relationship with a primary provider, and how that impacts strategy.

To hear Keith and Sukanya discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

The previous two episodes of Healthcare is Hard explored the “new normal” from the provider perspective with heads of strategy at an innovative regional health system, OhioHealth, and one of the nation’s largest, CommonSpirit. For the third episode in this series, Keith Figlioli welcomes Humana’s Chief Strategy and Corporate Development Officer, Dr. Vishal Agrawal, to shift the discussion towards payers and how they’re adjusting to the post-COVID world.

Today, Humana is one of the nation’s largest health insurers that also provides payer-agnostic primary care, home health and pharmacy services through its CenterWell brand. However, delivering health care services is not new to Humana. The company’s roots date back to the 1960s where it began as a nursing home business, and by the 1990s, it grew to become the nation’s largest hospital company. While its care delivery assets eventually merged into HCA Healthcare as the company focused on insurance, this deep history provides a unique advantage as the industry continues its shift towards value.

In this episode of Healthcare Is Hard, Dr. Agrawal shared some of the strategic priorities for Humana as he helps the organization navigate the new normal in healthcare. These include:

• Breaking the facility-centric model. The pandemic forced healthcare organizations to think differently about where and how they operate, accelerating the adoption digital and in-home solutions. For Humana, Dr. Agrawal describes how this was a focusing mechanism to help the company think about what it does best, and how it could enhance and integrate those pieces to deliver a more omni-channel approach to healthcare that people desire. This included doubling-down on the primary care, home health and pharmacy services Humana delivers through CenterWell and creating an integrated delivery system with a core focus of keeping people healthy. With this strategy, and a business especially well-suited for the Medicare Advantage payment model, Humana also announced in early 2023 that it would exit the commercial insurance market to focus on government-funded programs.
• Chronic care management. In a health system that was designed around the fee for service model and does a wonderful job treating conditions for sick care, Dr. Agrawal believes one of the biggest missing pieces is a similar focus on chronic care management. He’s excited about the opportunity for building an integrated delivery network (IDN) that brings together high touch areas that can manage chronic health conditions more proactively, and is optimistic about the ability of the Medicare Advantage model to help push the industry in that direction.
• Removing waste from the system. Dr. Agrawal points out the extreme waste in the healthcare system – which by some estimates surpasses $1 trillion annually – and how eliminating that waste should be a key focus for everyone. He talks about opportunities for reducing avoidable admissions and ER visits by keeping people healthier and innovating in areas like nephrology, cardiology or oncology where much of the disease and health burden exists.
• Consumer choice & personalization. Healthcare is intrinsically personal and as a result, requires many different options for people to choose what’s right for them. Dr. Agrawal describes how Humana is tailoring plans to meet these needs and uses the example of the Humana Honors Plan that it built in partnership with USAA around the capabilities of the Veterans Health Administration. He believes we’ll see more customization in areas like this as healthcare becomes a more consumer-driven market.

CommonSpirit Health is one of the nation’s largest integrated health systems comprising 142 hospitals and 2,200 care sites across 24 states. Three years ago, at the height of the pandemic, CommonSpirit’s Chief Innovation Officer, Rich Roth, and now former CEO, Lloyd Dean, spoke with Keith Figlioli on the Healthcare is Hard podcast to discuss their approach to leading the organization through healthcare’s most challenging times. As the country emerges into a new normal, CommonSpirit’s Chief Strategy Officer, Sheri Shapiro, joins the podcast to discuss how she’s leading this large organization with diverse markets and service lines into the future.

Sheri recently joined CommonSpirit to lead strategy in June 2023, undertaking a wide ranging role that spans responsibility for market strategy and development, growth and partnerships, strategy transformation, innovation, marketing and communications, brand management, the international division, sales and payer strategy. She brings more than 20 years of healthcare management consulting, health system leadership and brand management to the position, including seven years leading strategy at another one of the country’s largest health systems, Trinity Health.

In this episode of Healthcare Is Hard, Sheri talked to Keith about how she views the new normal and how she’s helping CommonSpirit navigate these uncharted waters. Some of the topics they discussed include:

• Guiding principles for a large health system. Sheri described the three most important things she evaluates for setting high-level strategy at a large health system. First is defining the common thread that a health system will be known for across all sites – the one unique advantage and competitive differentiator. Second is setting individual market strategies that align with the fundamentally local nature of healthcare delivery. Third is the operating model of the company, which serves as the glue that holds system and market strategy together. Without a model that enables local markets to operate efficiently while leveraging “systemness” and scale, Sheri says a large health system will be unable to execute.
• Portfolio rebalancing. Sheri talked about how the new normal has been impending for quite some time, citing examples like the shift from inpatient to outpatient starting more than a decade ago and challenges with rising costs growing for even longer. With events including the pandemic accelerating the need to transform, she talked about her beliefs around portfolio management and thinking through how to best deliver every service across the system and in each market. This includes examining the organization’s presence in every market to ensure it’s playing an essential role, and where it’s not, looking for opportunities to transform.
• Misconceptions of healthcare economics. Most people have a gross misunderstanding of healthcare finance and how different it is than other industries. Sheri discussed the mix of fixed and variable costs in healthcare and the inability to control revenue like other industries can. She used the simple example of restaurants that have trouble hiring and can adapt by paying staff more and raising prices almost immediately – a level of control healthcare providers just don’t have. She says there will have to be a fundamental change in the economic model of healthcare, and without policy reform, she says it will impede the industry’s ability to transform.

To hear Keith and Sheri talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

There are many reasons why central Ohio is a fertile ground for innovation and why the areas surrounding Columbus are ideal for testing new approaches to consumer behavior. It’s a diverse city with five Fortune 500 companies and 19 Fortune 1,000 companies in a wide range of industries, from banking and insurance to fashion. No single industry contributes more than 18% of GDP and together, they bolster a region that’s experiencing active and sustainable growth. In addition, Columbus has a relatively low cost of living, temperate climate and demographics that are reflective of the country at large. The bottom line is this well-balanced community creates an environment of low volatility that makes it an ideal place to try new things.

These attractive attributes extend to healthcare as well. Central Ohio has a diverse payer market where no one payer holds more than a third of market share. Several leading health systems support the community, including OhioHealth, which is one of the largest. OhioHealth is a faith-based, nonprofit system with 35,000 associates, physicians and volunteers, and a network of 14 hospitals, 200+ ambulatory sites, hospice, home health, medical equipment and other health services spanning 47 Ohio counties.

As OhioHealth’s Chief Strategy and Transformation Officer, Michael Krouse is responsible for the future direction of the organization and ensuring a strategic framework that delivers operational excellence and growth by meeting consumers’ needs with a diverse portfolio of services. Michael joined OhioHealth as CIO in 2007 after spending the previous 20+ years in healthcare executive roles at UW Medicine, First Consulting Group, E&Y and Arthur Young in the Pacific Northwest.

In this episode of Healthcare is Hard, Keith Figlioli spoke with Michael to explore “the new normal” in healthcare and what the industry will look like at it settles into the post-COVID world. Michael discussed his perspective and predictions on the new normal including:

• The sweet spot of scale. As a $6 billion health system, OhioHealth is a growth company at its core. But Michael says the path to becoming a $20 billion system is not as urgent as it was a few years ago. He points to health system megamergers and the difficulties those organizations have had driving ROI, and discusses how the market is rewarding systems with greater focus.
• Lumpy operating margins. While volumes are recovering in many places around the country, margins are still inconsistent for most systems and the rebound is not enough to avoid making tough decisions. With margins that are less than what’s required to fund growth and capital for many health systems, Michael foresees the need for major decisions around cost savings and efficiency that will be required for survival.
• Spinning up new business lines quickly. The healthcare industry is not historically known for quickly or successfully establishing new business lines where it lacks experience. Michael believes this will have to change in the new normal and says one path to success is through partnerships. He discusses examples of OhioHealth’s partnerships with ChenMed, Privia and Devoted Health and how they helped deploy new capabilities far more quickly than doing it alone.
• Inside innovation ecosystems. Michael shares his strong beliefs on the strategic role venture capital and private equity relationships can have helping health systems anticipate market needs and transform in a way that differentiates them. He talks about OhioHealth’s approach to strategic investing and business incubation, and how it’s always driven by the operational interest of the health system.

To hear Keith and Michael talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Before taking responsibility for operational performance of Booz Allen Hamilton – the $9+ billion technology and consulting leader with 32,000+ employees worldwide – Kristine Martin Anderson built a career pioneering healthcare IT. Most notably, she spent nearly 14 years at an early innovator in the space, CareScience, where she helped advance work in quality measurement before overseeing the launch of the nation’s first web-based clinical decision support system for hospitals, and the nation’s first health information exchange, among other groundbreaking initiatives.

After CareScience, Kristine joined Booz Allen in 2006 to help grow, and ultimately run, the firm’s healthcare business. Kristine later became president of the firm’s civilian sector and ultimately ascended to her current role as chief operating officer. Nearly all of Booz Allen's business is through government contracts, and its clients include all of the cabinet-level departments of the U.S. federal government, from defense and homeland security, to transportation and public health.

Kristine’s extensive work with the government and experiences pioneering healthcare IT put her in a unique position to navigate the complex demands of the healthcare industry. She shared some of her knowledge with Keith Figlioli in this episode of Healthcare is Hard, where they discussed topics including:

• Advice for winning government contracts. Kristine’s biggest advice for organizations looking to drive healthcare innovation through government contracts is that it’s not a good side gig. She says working with the government is a commitment because it’s a customer with long sales cycles, unique requirements and a need for transparency. But it’s also a big customer, which she says has the best missions and really important tasks that have to get done.
• How AI adoption will be slow and uneven. Kristine shares the industry’s excitement for artificial intelligence (AI) and its potential to transform healthcare, but offers words of caution around expectations for rapid, widespread adoption. She points to the example of using AI to analyze radiology images – one of the first applications of AI in healthcare – and the fact that it has still only reached 2% of all images. She also predicts and discusses why government policy makers will be more reactive than proactive when it comes to regulating AI innovation.
• The state of quality measurement. “Culture is eating strategy for lunch in the measurement world,” according to Kristine. She says quality measurement has lost its way as an unintentional consequence of Meaningful Use and the movement towards linking quality measures to health IT. She laments how meaningful data still isn’t available to the public in a way that can help inform personal healthcare decisions and says reporting has become more about getting government incentive for healthcare organizations.
• Prospects for entrepreneurs. The need for innovation in healthcare is bigger than it has ever been before, and Kristine is optimistic about the ability to empower startups and the people behind them to change the world. Her advice for entrepreneurs is to closely monitor the issues that will affect adoption. She points out how the best ideas don’t always prevail and says that focusing on levers for adoption is just as important as an innovation itself.

To hear Keith and Kristine talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Earning a Presidential Management Fellowship after law school gave Kristen McGovern firsthand experience working inside many of the agencies and offices that drive U.S. healthcare policy. Over a two year period with the Department of Health and Human Services (HHS) she worked at organizations including the National Cancer Institute and the Biomedical Advanced Research and Development Authority (BARDA). She eventually landed at the Office of Management and Budget (OMB) just as the HITECH Act was signed into law in 2009, dedicating nearly $30 billion to modernizing healthcare IT.

As the executive office that oversees the federal budget and federal agencies, Kristen worked closely with leadership at OMB and HHS as they deployed funding for Meaningful Use and other programs catalyzed by the landmark legislation.

In 2010, around the same time the Affordable Care Act was passed into law, Kristen was recruited by Farzad Mostashari (a previous guest on the Healthcare is Hard podcast) and became chief of staff at the Office of the National Coordinator for Health IT (ONC).

These experiences launched a career that has put Kristen at the forefront of federal healthcare policy and politics. She is currently partner at Sirona Strategies, a healthcare consulting firm she co-founded to advise organizations – from startups to the Fortune 500 – on healthcare policy.

Some of the topics Kristen talked to Keith Figlioli about on this episode of the Healthcare is Hard podcast include:

• A pulse check on DC. Kristen shared insight into the offices and agencies shaping the healthcare industry from inside the beltway. For example, she talked about the current state of the Center for Medicare & Medicaid Innovation (CMMI), the activity she says is happening “below the surface” and how the organization is at an inflection point after more than a decade testing payment and delivery system models.
• The evolution of Meaningful Use. Looking back at her time at ONC, Kristen talks about the initial goals of encouraging EHR adoption to unlock insight from paper records that were sitting in filing cabinets. She talks about progress the industry has made and the current goals of making sure organizations can access and use data in new and innovative ways. In other words, ensuring we haven’t just created electronic filing cabinets.
• The size and scope of AI Policy. With all the enthusiasm about artificial intelligence (AI) in healthcare, Kristen talks about the process of putting guardrails around this powerful technology. She says it will require a large-scale collaborative effort across HHS and other government agencies, and believes it will ultimately be an even bigger undertaking than Meaningful Use.
• Policy advice for startups. As a highly regulated industry, every organization that touches healthcare needs to be aware of the impact current and future policy decisions could have on their business. Kristen shared advice about how she helps startups think through the impact of policy decisions, and when and how to embed policy experts in a business.

To hear Keith and Kristen talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.