Successfully Scaling the Care from Home Model with Hank Schlissberg President of Davita Health Solutions
Welcome to the outcomes rocket podcast where we inspire collaborative thinking improved outcomes and business success with today's most successful end inspiring healthcare leaders and influencers and now your host I welcome back to the podcast today. Have the privilege of hosting Hank Schlossberg Hank is the president of Davita solutions found that in two thousand sixteen Davita health solutions purpose is to improve the quality of life for what they call our nation's most vulnerable patients M._v._p.'s the highest risk patients who have multiple complex chronic conditions and high utilization of the healthcare system with with full clinical and financial accountability for the defined set of patients Vida health solutions goes far beyond the vitas traditional kidney care focus to reinvent the care model at scale across a market for the highest risk chronic patients through house calls Post Acute Care Behavioral Health Palliative care and other social services. This is on the minds of a lot of us today as health leaders and Davita health solutions has extraordinary impact with ninety one percent patient patient satisfaction ratings thirty seven percent fewer hospitalizations seventeen percent cost reduction and so on they're doing incredible work that we're GONNA be diving into today. Prior to joining Davita Hank was partner at McKinsey and company where he joined the Cleveland Office in two thousand and remained in unto twenty eleven. He's had a lot of different leadership roles in healthcare and it's a privilege to host him here in on the podcast from Denver where he lives with his wife Life Caroline and their three young girls where they love the Colorado outdoor lifestyle so hank such a pleasure to have you here. Yeah faiths all excited to be here so hank anything that you want to touch on that. Maybe I left that your intro. No that's great great. I think <hes> there's so many great things happen in healthcare these days and so it's fun to be able to talk a little bit about it a large story and and there's so many others that have been featured on your show and others. Hey Hang so what is it that got you into healthcare to begin with. You know a lot a lot of it's always just the serendipity of of consulting. I was working helping McKinsey as you said I I didn't understand healthcare. I don't know that I was naturally drawn to it and sometimes just serendipity of getting staff on a project. I'm starts you off and then one thing leading to another is is much more of of my story now having said that once I started to understand the complexity of the problems that hope you're presented the nature of the people that therefore attracted acted and ultimately once I got connected to our patients and what they're going through I was I was forever hooked. That's interesting and so from consulting to really a very involved partner in health care with Davita. What would you say hank the needs to be on the minds of health leaders today? How are you guys tackling? It also scale ability most of us in health care pretty much know the right answers for the system and for individual patients and we've seen him the in play out in amazing ways in in smaller pockets. I think the question is how those who finance the Karen our country so that's largely the government employers in commercial payers can drive solutions at scale so oh C._M._S.'s recent overhaul and expansion of the A._C._O.. System through what they're calling primary cares is a is a terrific example. A great example for Davita health solutions is at the core of our care model which you mentioned which is House Calls House called or a highly. Logical approach to care for the highest risk most chronically. Ill It's happening for hundreds of years. It's really hard logistically in the investment required poll off high risk polly chronic patient care through model like house calls. It's really tremendous to do that at scale and so it doesn't make sense to keep with our sort of skill ability theme for every individual hospital or every individual practice in a market to each build these capabilities make these investments one all the infrastructure should be built one time through those financing the care. I one provider for for everyone's use in a given market yeah you know it's definitely at the forefront of a lot of the challenges that the providers providers are faced with and and payers so it's interesting that you guys have developed a model to address this really big pain points and so I love to hear from you what <hes> the organization has done to create results in doing it differently you let me pick one specific example and see if it resonates and we've been spending a lot of time lately thinking about patient engagement right. It doesn't matter if you have the the right clinical pathways the right data the right bottle of pair. If you take the patient to actually actually engage with you or engage in their own hell it won't have impact and so one of the things we're doing it to be. The health solutions is we're bringing talent and thinking from outside of healthcare on how you build trust with consumers what is the best thinking thinking from the fields of Haber Economics and data science to fundamentally rethink patient engagement because we have to move from a world where good is forty percent engagement in some disease management program to a world where eighty or ninety percent under the patients that were accountable for are actively engaged with us and taking in in their health and the reason this is important. This is sort of what you said in your intro is because when we touch a patient we reduce their hospitalizations by forty percent and more than ninety percent of them unless analysts they had a great experience so we feel an obligation to give that gift to as many patients as possible in the contrast that I often use with my team and others when we think about a comparison around around trust and engagement and and being in the home home is Airbnb so here's a business where where I can sleep in someone else's bed I can shower in their shower and somehow both sides have convinced themselves. That's completely normal right until I think we've got to get to that point. In healthcare where we can break take down some of those barriers the way people other industries Ga- that's a that's a really great call out and so you mentioned hank the house call and you know you envision the the white coat with the black bag and you know the old school way of doing things. How much technology are you guys using along with? The House calls yeah. There's remote monitoring you know yeah yeah. There's a huge amount so remote monitoring and telemedicine are certainly important parts of Macaire model. I would say probably one of the most advanced ways that we're using technology is in the field of data science predictive analytics and artificial intelligence so this is a huge part of of what we're doing and probably one of the most important learnings that we've had so far which is how do we use a to make sure identifying the right patients so as I said patient engagement is a is a huge challenge for us and for all in this industry and one of the reasons the challenge is sometimes you can actually find false positives in the data you can call these patients up and and offer them what seems like a really exciting value proposition right. I'm I'd like to come into your home and provide you free healthcare right. That sounds like a great opportunity. Opportunity and oftentimes they say you know I feel great right now or I'm at work or at tennis right now. So we now have such advanced predictive algorithms that we can accurately predict not just hospitalizations Jose Shins or readmissions like a lot of people do but we can actually predict future disease related costs so so it's a lot more helpful to know that a diabetic will have diabetes related costs or kidney related costs or heart failure related costs because now we know who and how and when to intervene and so when we run this type algorithm against large data sets like the Medicare data we find that sort of traditional ways of identifying patients through chronic conditions <unk> can oftentimes identify as much as two thirds of false positives being patients who probably were going to become less acute on their own and at the same time Miss Miss as many as two thirds of the patients that we might otherwise have selected and been able to give our gift to so moral the story Ah Combo of both is the Best Yup for sure no question Gotcha and so so how about on the on the you know you guys haven't always had a system system. That's produced results the way you're producing results now with these <hes> the most chronic patients tell us about a time when you had a setback and what you learned from that we're all entrepreneurs so they're nearly daily right a holiday. I think a good one I was thinking about is actually in my previous company before Davita which was about a forty million dollar venture back company who is trying to disrupt in innovate around the clinical and Business Model for radiology and this is about five six years ago and and to this day I think we had a great concept and almost everyone I speak to you about it still says how did that not were yeah but it didn't it didn't and I think most the concept in a nutshell. The Concept was to Aggregate Radiology Volume Radiology Exams and studies and radiologists again optimize so that every single read could be done run by a sub specialist who had proven that they were world class at reading that type of study so we know for a fact that if you need an m._r._i.. Of The rain on a nine year old you want a pediatric neuro radiologist reading that study and that doesn't always happen when you have a six person radiology group and so we were trying to aggregate this and I think what we learned was that hat we were a little bit too early. The the evolution value base care hadn't fully come to fruition the inertia local healthcare was challenging and so you ask what were the learnings learnings for entrepreneurs were sometimes you are just too early and and calling it early versus late as skill unto itself and then and then also sort of while we saw the long-term vision correctly we probably could have done more to find other ways to add value to our clients in the meantime create revenue learn aggregate data things like that and it was important Laurie now that that's really interesting and so as the listeners are thinking to themselves wow you know fascinating topic your provider listening to this thinking to yourself. Maybe I could work with Hank in his team to take take care of that population for me and Emmy thinking well. I'm already contracted <unk>. Have something in place within you know I have an A._C._O.. Or I'm working with my hair to do something like this. What would you say to them and I would go back to this point about scale ability? which is every individually C._O.? Will have iris patients every individual practice. Every individual health system will have high risk patients if you think about the investment that we've put into into building these capabilities a customized e._m._r.. That's at the intersection of ambulatory and home health the predictive analytics that we talked about the scale and density in a market just to optimize routing and logistics in the software to do that the care pathways for such complex conditions and I could go on and on and on about the investments that we've made it's nonsensical to us every individual practice in a market or hospital in a market would build those capabilities and so what we would say is in and it doesn't have to be us but fine folks who can build these capabilities in scale them across an entire market an entire geography and let's take care of the the patients highest risk patients in that market at scale and do it one time because we know right by definition if everybody is building it differently by definition. It's not optimized right now. That's a that's a great message at so so really just the message here is find a partner because we really can't be specialists that everything and healthcare's really super complicated hanks messages find a partner that could do it. Well doesn't have to be the vida find a partner to focus in on this particular subset of patients and so on that topic Hank. I love to hear from you. What one of your proudest leadership experiences has been yeah? We'll like I said for me now. As my career is involved it has sort of all come down to the patient and so I can literally remember my first house. Call a ride along like it was yesterday. The patient was Miss Harriet. We were in her bedroom and our nurse practitioner was getting to know her while our social social worker was spending time with her daughter in law in on the one end. I was very proud prideful of seeing our work unfold realtime but on the other I felt pretty helpless. Just as I was started the business guy in the room right and I'll never forget that I saw aw alarm clock in mysterious bedrooms flashing like when the power is gone out just needs to be reset and I just kind of walked over and reset and mysterious doctor conversation with our nurse Practitioner and she said head thing. It's been flashing for weeks. That might be the most impactful thing that would happen to her all day. Leaking alarm clock was really bothering her. Keep in mind. This is a patient who had three strokes in the last six weeks. Who who still wasn't on a cholesterol medication wasn't in the right protocol? It could have been anybody but I made a difference just like fixing her alarm clock and that's when I knew that our model of being in the home now with our patients things where they are in their lives and everything that's happening was gonNA work. Wow that's a neat story Hankun in I can just picture everybody in the room and the lady just Kinda have a sigh of relief from the alarm clock and then your care team just is delivering the solutions that she needed. That's key. I remember having a conversation with somebody at Ted Med and they did some study. She was telling me about choosing academician and she worked on some study with C._M._S. and they found that at having nurses show up in the home they discovered things that really it didn't cost much but like a crease in the rock that would have been a falling hazard or a clock right that that was just annoying them. It's just incredible what. Of being present bats yeah yeah it really is and so we talk a lot about this concept of social determinants of health and all these things that you're talking about whether it's fall risks or Putin security or transportation ocean or loneliness or things like that they're often as impactful not only to the patient in their experience but even to the overall cost of care that will ultimately result as anything that will do quickly so thank you and I had a discussion before the podcast then I told you hey you know what on my misconceptions was. Hey Davita kidney dialysis right. I mean it was just a for me an eye opener to learn about the great things that the Vita health solutions is doing what midst it's would you. Would you like to dispel for the listeners today. Well vitas ultimate objective is to make a difference in the lives of of all the patients that we serve so for sure. Dialysis is a huge part of what we I do and we're one of the world's leading players in that we also spend a tremendous amount of time thinking about other parts of kidney failure in addition to things that we do indeed health solution so an example would be we're spending a lot of time thinking about getting upstream to patients with chronic kidney disease before they ever get to dialysis and hopefully the lay the progression to dialysis if not even avoided needed and then if they do have to move on the dialysis making sure that they're fully educated about all the different modality options all the different options for whether they wanNA treat home or in a center a what their options might be for transplant as as well and so I think we're thinking about ourselves much more as a chronic condition management company and a broader renal focused company than just someone who operates in center dialysis brilliant so out of all the projects that you guys is are working on Hank. What would you say is the most exciting today we'll twenty in our conversation? We've actually hit many of them. Were <HES> so we're spending time thinking about social determinants of health and behavioral health and other ways impact the patient were all suspending a ton of time <music>. I'm thinking about as as we call predictive analytics and A._I.. And so you know I think just to reinforce that the idea of being able to identify patients who are one most in need of our care and to who are most likely to engage with us in a model such as this so we can have impact is probably the most sort of insightful and new and revolutionary thing that we're doing. I think what we find is most health plans. Dan Don't even always have a perfect view of who will be there sort of most acute most chronically. Ill patients over the next few years and so using some of the data science that we've put together. We'll develop a pretty good perspective on that which then allows houses target. Are you know Hank. I it's really interesting. I find it fascinating how the company is evolving to incorporate some of these newer technologies to help patients at the core of your mission in. I'm reminded of of Jim Collins Book. I forget what the lasting love yeah. They'll have you read it which your hope yeah and so you know when I read that book I had an epiphany. It was it was I I realized that a company is not defined. Find biproduct is that you've got a product you gotTA company but in reality it's the mission and I love seeing you apply some of those principles to Davita and seeing the company transformed so i WanNa definitely give you guys a lot of Kudos for the way you guys are changing. With The Times yeah thanks so <hes> getting here to the Lightning Round Inc.. You've got a couple of questions followed by a book that you recommend the listeners you ready yeah the lightning round. Let's all right. What's the best way to improve healthcare outcomes James? Let's stay with our theme of creating tailored care models and then the supporting payment models for specific populations around natural owners what the biggest mistake or pitfall to avoid not regularly taking a hard look at the business model title associated with Your Care Model and ensuring that it's both relevant and timely and and being willing to change willing to pivot willing to involve if it's not how do you stay relevant as an organization despite constant change constant change in and of itself is the answer you're talking about. We we strongly believe in individuals core value of continuous improvement and Davita health solutions. We have a guiding principle of embracing the adventure and I think those things sort of allow us to continue continue to evolve as as the environment around us does what scenario focused drives everything at Davita. Will we talk about something called the Davita Way and the Devito way talks about caring for each other with the same intensity that we care for our patients and we think that if we can do that it'll it'll shake many of the actions that we take with our patients. I love that and these next two hank are more on a personal note. The first one is what is your number one health habit my number one health habits is is riding my bike about it do long distance sir. I'm afraid of road biking and mountain biking so brain trails. We have great trails here in Colorado in Denver Ed so I was out there this morning on the trail. We'll try to get better than man. You have good reason to be afraid. It's <hes> it's definitely dangerous. I've had a lot of friends get get real hurt with <hes> with both actually your arm as the Road Yep Yep and the second one here Hank is what is your number one success habit my number one success habit is be open to feedback we try and <hes> critic culture of being very open to these conversations and hearing from the team whether that's <hes> formal surveys after meetings whether it's one on ones where we asked for reciprocal feedback as much as possible. I think we all have tremendous room for growth in often blind to let those areas are love that too great tap. What book look would you recommend? The listeners Hank was you've gathered I'm kind of a sucker for entrepreneurship and innovation so I'll recommend to from the Mount Rushmore of of Entrepreneurship and Innovation <hes> Jeff Bezos the everything store A. and Walter Isaacson biography of Steve Jobs the everything start I haven't I haven't picked that one up but is it. Is it yeah it's basically the story of Amazon from circa finish. I love it definitely going to pick that one up Hank appreciate the recommendations folks good outcomes rocket that health and in the search bar type in Davita or type in Hank and you're gonNA find all of the show notes for today's discussion as well as a full transcript in links to the work that Hank and his team up to this has been a ton of fun. Hang I love if you could just leave us with the closing thought and then the best place for the listeners could continue the discussion with you and your team Yav easiest way to fall me is just hey at Davita dot com so that's very simple in my closing thought is just on this idea of innovation entrepreneurship in continuous improvement. I think none of us would claim that we've got the U._S.. Healthcare system figured out for the patients the providers or the payers and so just being open to the new models of care new business models and new approaches I think just benefits all of us and our and our children's generation Hank really appreciate your thoughts and <hes> and again just want to thank you for spending time with us. Thank Saul who was blessed.