The Reverse Mullet Healthcare Podcast
Ellen Brown, Justin Politi, and Dave Pavlik bring their 90 collective years of healthcare experience to BP2 Health where they're on a mission to effect real change in the industry. Connect with BP2 Health Here: https://bp2health.com/contact/
The Reverse Mullet Healthcare Podcast
The Dire Need for the Rational Use of Data (and 250 Dogs) with Dr. Dan Elliott
When health care meets data with a side of humor, you get a discussion that's as entertaining as it is informative. Queue up our latest episode featuring Dr. Dan Elliott, the EMR and population health maestro and Chief Medical Officer from Delaware First Health (Centene). Dan brings his journey full circle, from the halls of Christiana Care to the studio with a whiteboard marker always at the ready, proving that an approachable focus on data can indeed drive serious improvements in patient care.
Life's unexpected moments, like fostering nearly 250 dogs or transforming a basement into a soccer field for family fun, are the catalysts for deeper connections within our communities. Dan's eclectic mix of passions, from gardening figs to coordinating large family ski trips, paints a vibrant backdrop for our discussion on compassionate healthcare leadership. His stories remind us that joy and a well-lived life outside the clinic are the unsung heroes of patient care innovation.
As we wrap up, we don't just share insights—we celebrate the synergy between providers and payers striving for a robust, primary care-focused healthcare system. Dr. Elliott's experiences, from both sides of the care continuum, underscore the collective journey towards a system that truly works for the patient. Recorded in the studio, where the power of in-person connection brings an extra dose of warmth to the healthcare narrative we're all a part of.
Welcome to the Reverse Mullet Health Care Podcast from VP2 Health. Today we are in Mainline Studios in Westchester, pennsylvania, talking with Dr Dan Elliott, chief Medical Officer at Delaware First Health, about the dire need for the rational use of data, including the ruthless elimination of fancy. But first, who are we? Why are we here? Why are we? The Reverse Mullet Health Care Podcast? We're a new mug. You're excited by this. I am.
Speaker 2:Very excited about it. Why did we name it the Reverse Mullet?
Speaker 3:Well, we want to be relevant informative and creative, but you also want to be entertaining and have fun. So it's party in the front and business in the back, like a mullet, only reversed.
Speaker 2:We are your hosts, ellen Brown.
Speaker 3:Justin Politi, Dave Pavlik.
Speaker 2:We are passionate, innovative and collaborative and are committed to solving our industry's most important issues together with our clients. We have the three of us that combined 90 years of experience.
Speaker 3:It makes us sound so old.
Speaker 1:And when we add Dan to the mix, what have we got?
Speaker 4:120 probably right Hard to believe.
Speaker 2:In each episode we will dig into a hot health care topic and dig into each other.
Speaker 1:We do not dig into our guests, at least not too much and you have to be gentle on me. No chance, no chance, not at all. So we are super excited to have Dr Elliott on the show. Ellen herself is a self-professed data geek. I'm right there with her. But I actually think Dan can probably put us both to shame and I'm sure we'll get into that.
Speaker 2:Yeah, so after I read your intro, dan, everybody will understand why you can put us to shame both of us in our data geeks category. So everybody get ready because this is one heck of a bio here. So Dr Elliott is currently the chief medical officer of Delaware First, where he is responsible for population health activities, which include care coordination, care management and long-term support services, utilization management, quality, behavioral health, pharmacy and dental.
Speaker 1:Is that?
Speaker 3:all.
Speaker 2:Yeah, right, and next year it will be.
Speaker 3:What services are not covered? Oh, there's a lot, there's a lot.
Speaker 4:We have a great team that covers a lot of bases.
Speaker 2:Yes, I think it'll be a year for Dan in this role, but it was prior to this when we had the honor of meeting Dan and getting to work with Dan. At the time he was the medical director of Ebride ACO and Christiana Care Quality Partners. He wore many hats during his tenure at Christiana, including associate chair for research and scholarly activity in the Christiana Care Department of Medicine. He was the project co-director and director of Evaluation for Bridging the Divide, a project funded by the Center for Medicare and Medicaid Innovation aka CMMI one of our favorite acronyms to develop care management services supported by information technology to improve the quality and cost of care for patients following coronary revascularization. Yes, I said that correctly and I did not practice.
Speaker 4:Are you sure?
Speaker 2:Yes, he is a man after my own heart, with a degree in economics Thank you very much. But his dual major is in political sciences, mine only in finance. So again, the fact that you have you have such varying degrees is impressive. And he's also a medical doctor. So he went on to earn his medical degree while contemplating an MBA.
Speaker 2:He completed his residency in internal medicine and pediatrics at Christiana along with what is now Nemours. During residency, he served as chief resident and, as if that wasn't enough, studying he subsequently completed a fellowship in the generalist scholars where he earned a master's degree in clinical epidemiology, where they focus on outcomes research. This is where we get into the data part at U-PEN. While that was interesting, he knew he didn't want his life's work to be grant writing, but instead wanted to use data to have an impact. Luckily, his primary research mentor at the time, Ron Karen, now CMO at CHOP, helped him learn how to use EMR data for applied purposes. He was also given a fairly rare opportunity to spend time. I liked how you said this quote, unquote, figuring it out, that's right.
Speaker 2:Oh, I hit the microphone. This is going to be.
Speaker 2:I'm going to do this it's like a penalty and worked through every day. He used that opportunity to work through every data source he could find operations, financial contracting, emr, clinical quality, copayment, elimination with Mark Frederick and disease management. He has written papers and grants. He has been published, was awarded I warned you guys, this was one heck of a background. He was awarded CMS Innovation Awards but ultimately knew he wanted to be operational. And until this new role, dan cared for patients as both a primary care physician and hospitalist in Wilmington, delaware, for 20-plus years. Dan happens to be a Delaware kid where he and his wife live a combined five miles from where they grew up. But, dan, you have to tell everyone what your Christiana team gave you as a gift when you left for your new position, because I loved this.
Speaker 4:Well, I appreciate the opportunity to be with you guys and to share the story and the history and, obviously, the things that I've been up to in the past and up to now and, honestly, things that you taught me a lot in our time together. So, to start with the get oh penalty point for me, I know I'm so sorry.
Speaker 1:This is going to be a. I'm going to keep the merit, I'm going to start keeping score.
Speaker 4:So this is actually I'm pathologic.
Speaker 2:I brought it, I'm so excited.
Speaker 4:I thought we'd have props. It's going to be hard. This is awesome. So I am pathologically addicted to the whiteboard. I don't know if any of you guys share that ailment.
Speaker 2:I do like to drop. Yeah, they're all pointing at me.
Speaker 4:Even my Delaware first health team during our first retreat. They said he has some problem with markers. Like, I just sort of grabbed them. I like colors, I like to play, but I've always drawn things.
Speaker 3:Can we get the full picture of that we?
Speaker 2:Oh, and it's on the e-brain. I know that logo, so OK, so for those of you listening, he's holding up a blanket.
Speaker 1:That was a gift. That looks like a bunch of different, so people must have taken pictures of your whiteboard drawings over the years we had the best team. And then they put them onto a blanket for you. That's pretty cool.
Speaker 4:And Sarah Reynolds, who is one of my faves, and she gave this to us.
Speaker 2:It is a cozy blanket. My daughter would love that blanket.
Speaker 4:It's in my office. I occasionally curl up with it when it's one of those days. But it just reminds me, when she gave it and the team gave it to me, they said we can't let these drawings go to waste, and I actually learned from people to use these sort of I think in pictures, I think in sort of organizational structures, and it's helpful to put them down on paper and help people sort of connect to that I know nothing about this.
Speaker 3:Yeah, right, exactly, we share that in common, I think so. Anyway, that's the gift. What a super thoughtful gift. This is like really.
Speaker 2:That's spectacular.
Speaker 4:Very special, very special.
Speaker 1:I'm curious about all the statement you made to us while a chief resident. You wanted to learn how to use data to fix health care and you never found anyone who could show you how. So they told you just go do it.
Speaker 4:Tell us about that, yeah it was actually a great story, a great time in my life, and I use it when I reflect back on my journey and particularly when I counsel other folks. I went to medical school on a primary care scholarship through the state of Delaware, so I knew I was committed to coming back to Delaware and I went through residency. I was again very. I bought hookline and sinker. I still do. The value of primary care, the mission of primary care, what that meant, what that looked like, that was my understanding of what a physician was and could be.
Speaker 4:So when I was going through residency, I was asking all these questions and I was asking about data and trying to answer why do we do this? How do we fix things? And I had a hard time understanding how to ask a question, get the data to support it, draw some conclusions and then move forward. I just didn't know how to do it and I felt like it needed to be done. So I actually give a lot of credit to now CEO at Christiana, janus Nevin. She was then the chair of Family Practice and I was meeting with her as a chief resident and I was honestly trying to convince her to give me a different job and create a job for me.
Speaker 2:I've never really.
Speaker 4:I've actually never had a job that anybody before me ever really had. So I guess it started early and I was trying to convince her to sort of create this opportunity for me and she said really, really interesting, what do you really want to do? And very insightful, made a mark on me and I said I just want to learn how to use data and how to fix health care. And she said you should do it. And I'm thinking got a wife who's taking the semester off from her job to take care of our two young kids. I've got a mortgage. I don't know, is this a real thing? Can I really do this? And she said you should.
Speaker 4:And between her and our then chair of medicine, dr Virginia Collier, they gave me the opportunity to go, and so I spent two years at Penn. It was just an amazing time. My wife said don't go get a real job and then go back to school. So if you want to do it, do it now. And so she supported us. She supported me as we went through it. It was amazing. So I learned those things. And then I came back and Dr Collier then and the team created space for me at Christiana to go figure it out and health services research, applied outcomes research. I mean, this is circa 2007, 2008. Really new stuff. Quality improvement research, implementation research those things weren't even terms that we were using regularly and I didn't really have a concept for it, other than I want to know how to do it. So I'm grateful for the training and grateful for the folks at CHOP and Penn who taught me and gave me the skills I needed, and it was kind of off to the races from there. That's incredible.
Speaker 2:Yeah, that's awesome, so I think I got this right. You met your wife on your first day of preseason as a freshman in high school, and not only are you still married but it's been almost 25 years and you have four kids that you homeschool. Yes, and you still live at home. Yes, that's right.
Speaker 4:And it's been an incredible journey. I was 13. My wife was 14. So it was kind of a funny day. We always talk about it. I was waiting for my first day of preseason. I was getting picked up and this guy pulled in and one of those classic grand wagon ears with the navy blue, with the wood trend.
Speaker 1:It's like we have one of those.
Speaker 4:Yeah, it's like an iconic truck and pulled in. I got in on the back right, didn't know anything. The guy was driving turned out to be my brother-in-law he also lives behind us, by the way now. So it's not only have we not gone far, but my brother-in-law and sister-in-law and their four kids live with us behind us.
Speaker 2:That's outstanding, it's pretty cool.
Speaker 4:But anyway, my wife, my future wife, was in the front seat and by the one word she said and kind of the scratchy voice and by sort of the back of her right ear that I could see in the side mirror, I was convinced that she was a senior, had to be a senior, right, it ended up being a freshman. We kind of were friends all through high school, started dating right at the very end. Here we are, 25 years in June of this year, which is pretty cool, wow congratulations, that's great.
Speaker 1:Yeah, that's awesome, that's awesome, that's awesome, that's awesome, that's awesome. That took you. Have a sound effect for that. Let's see if you can remember it. Yes, wow, there you go, great job, great job. I love it. Girl played, girl played, very well played.
Speaker 2:So wait wait, wait, wait, I just have to say I understand that your daughter loves to bake and so you don't need to eat now, but I did. And those people that are listening that listen to all of our episodes.
Speaker 3:We're going to record another People. That are people that listen to all of our episodes, apparently.
Speaker 2:Yeah, I don't know that they.
Speaker 1:I don't know.
Speaker 3:All right, I don't know.
Speaker 2:But thank you to those that do, but if you, we have a guest coming on, and so that inspired me to bake, and so I decided to bring some of said baked goods, and so they are sitting on the table, so feel free to partake in the baked goods.
Speaker 4:They are incredibly tempting. I understand they're crack brownies.
Speaker 1:It's good that we can't reach them. That's exactly what I had to hear, and you might hit the microphone reaching them.
Speaker 2:So it's just they smell. You can like waft.
Speaker 1:So Dan, do you actually have a soccer field in your basement?
Speaker 4:We're a big soccer family, we do a lot of things, so, yeah, so when we live in the house, we built the house that we live in right now when I built it so I have a left space in the basement and made sure that they sort of moved all the structures to the side and right around the beginning of right before COVID we started the process of finishing out that area, so yeah, so now it's like a 20 by 30 space. It's got turf on the bottom, the walls are all like I can kick a soccer ball as hard as you want to against it. It actually doubles as an unbelievable ping pong court.
Speaker 2:It's like the perfect size and perfect lighting for like a giant, a pickleball court, ping pong yeah, a pickleball we could do ping.
Speaker 1:Yeah, you could do that. Sounds big enough 30 by 30. Yeah, but the ceilings aren't that high 9 foot, which is nice. You understand his demographic right. Yeah, that's exactly it. He's bringing up pickleball. Do you have the wrist injuries?
Speaker 4:Do you have the wrist and ankle injuries to show that?
Speaker 1:they're a pickleball player. My shoulders don't work at all.
Speaker 2:No, but they didn't work before pickleball so but apparently you have the type of gear stash in your garage like I have in mine, so you have skis and snowballs and mountain bikes.
Speaker 4:It's a mess ATVs, golf clubs, tennis raccoons.
Speaker 2:And you like to garden.
Speaker 4:I love to garden. Yeah, I'm a proud fig father now.
Speaker 1:He walked in the door. I had my first fig. He walked in the door in the hallway outside of Mainline Studios here. And what is the first thing you said?
Speaker 4:I said that's a beautiful paddle-y fig. It's gorgeous.
Speaker 1:I just bought one Paddle-y fig out in the hallway. Really Like not a, a giant one.
Speaker 4:A giant one. Yeah, it's beautiful.
Speaker 3:He's the true Renaissance man. I love it. Where do you ski it's funny, we're mostly Poconos.
Speaker 4:I used to do more trips out west when I was younger, but with four kids.
Speaker 2:Yeah, I was going to say four kids go into the Rockies is not.
Speaker 4:Not all of us can be right on shooting distance from Breck right.
Speaker 2:At times in our life. Yes, I still have my cabin. There. Oh, my goodness, I love to ski so.
Speaker 4:I actually got out this weekend for the first time. I have a new snowboard this year, so I got out on Saturday. We were up there by 7.30 in the Poconos. Crowds got in about 10.30. So we went.
Speaker 2:There was snow.
Speaker 4:We got snow. We had five inches of fresh powder.
Speaker 3:It wasn't just dirt. That's awesome. So I have to jump in on because I'm a huge dog person.
Speaker 2:Wait, your socks. Am I allowed to? Maybe I'm not supposed to say anything. I have an old English bulldog.
Speaker 4:Oh, I love it I love it For the listeners.
Speaker 1:he's showing us his socks Apparently they have dogs.
Speaker 2:His dog, ollie, is on the socks.
Speaker 4:Oh, they're actually your dog.
Speaker 3:Yes, oh my goodness, my sister-in-law. I have to give her credit for, like she always is great Christmas gifts, and so this one surprised me. But going back to you, and I want to hear about the dog fostering 200 dogs.
Speaker 4:Yeah, it's actually closer to 250. Believe it or not, it was actually an ex.
Speaker 2:You were just a little bit off, I know right.
Speaker 1:Nah, it's funny, 200, 250.
Speaker 4:We lost the count because it was actually truly an exercise in teaching my oldest daughter how to use Excel. So I literally made her keep this Excel spreadsheet and then her hard drive went corrupt and we lost the numbers. But we started. It's my oldest daughter she's 21 now when she was about 13 or 14, we actually had a dog show up on our back porch broken leg, a little one-year-old boxer, and we called him Driveway Dog for a little while because the Driveway Fund went to this dog's surgery that fixed his leg. Beautiful story Ended up going on to another home. But that kind of got us started and since we homeschooled, my daughter was more flexible. She ended up having pregnant dogs. She became the Delaware Humane. She created this whole foster structure with Delaware Humane and we would get pregnant dogs. She would deliver them, she'd farm them all out.
Speaker 2:Is she a vet now? No, no, she's a jack of all trades. What was the most? What's the largest quantity of dogs you had under foster at the same time.
Speaker 4:I think one time we had two litters, one in the basement, one upstairs, and maybe the litter was eight and four, nine and five, something like that. So we had a fair number of dogs.
Speaker 1:One of our two rescues that we have right now. Similar story she was pregnant and a foster family who has also fostered multiple hundreds of all kinds of animals. They've done mostly dogs but pigs and just all kinds of things Build a chicken coop in the garage. But she was pregnant, they fostered, they raised the puppies and then they adopted all the puppies out and the mom. We took the mom.
Speaker 4:I love the sweetest dog ever. Yeah, we have a number in our sort of extended circle of people who have dogs that have been through our house, which we have two foster failures. So one is a tripod named Carson. So we're Eagles fans in our house, so it tells you he lost his leg right around the same time that Carson did his ACL.
Speaker 2:So it's a lens that is.
Speaker 4:ACL. I have a dog named Carson, who's wonderful, and then just last year we had our second foster failure. So we have this huge moppet of a dog, but isn't foster failure?
Speaker 1:you fell in love with him and did you want to answer that, but I'm just so impressed. It's not really a failure, that's 1%.
Speaker 2:Like that's only a 1% failure rate.
Speaker 4:So my oldest daughter is a leader Like, that's just what she is. She sets the temperature of the room.
Speaker 2:She like and she, apple, doesn't fall far from the tree, oh man, oh man.
Speaker 4:Well, she takes it to another level. But she convinced her three younger siblings and her four younger cousins, who live, you know, again right behind us, that we're just keeping these dogs and then finding them their home is the right thing to do, and so nobody ever questioned it. And but the one Carson we kept because my son was 12 at the time and he just bonded with this dog because we did surgery. We had him in the house for a much longer time and it was a huge gift to him around his 12th birthday we actually went to Delaware Humane Like we were giving him back. Then they announced overhead you know Joseph Elliott is going to adopt him, and it was his face went nuts. It was great, it was super fun Dogs are awesome Dogs are awesome.
Speaker 2:I guess we can have like a whole dog.
Speaker 1:I've got to ask you how many hours of sleep you get a night with three, four hours. No, you never said you got going on Well with our kids.
Speaker 4:If the kids bring them in the house, the kids take care of them, okay, so I was very clear. You play soccer like. The kids have been washing their own gear since they were, you know, was able to do it, so my wife's really good at that Good for you Raising responsibility.
Speaker 1:Congratulations, yeah, absolutely Okay. What do you think guys? Time to get down the business Help care Unfortunately. Yeah, yeah, business. I think there's a sound effect for that?
Speaker 2:What no, yes. There it is the business in the bag. No more fun stuff. Okay, all right.
Speaker 1:So our platform of the podcast, as you know, is discussing things that can affect real change. I'm saying real in air quotes, all caps. Real change in healthcare. Dan has been on a mission to create efficiencies in all areas of the healthcare delivery system and has a great statement the dire need for the rational use of data. So, Dan, what does that mean? Tell us about that.
Speaker 4:Well, you know it's really interesting being trained and sort of coming from that background of sort of real formal understanding about what data is, how you use it. I remember my first day in grad school, you know Brian Strom was leading the program at that point at Penn and he said the question is, what is the question? You know, and sort of this discipline of how do you ask questions, how do you frame them before you even go into data, before you start thinking about it. And I have a saying, actually, where I've told a lot of people this over the years. But I really think healthcare will be sort of most impacted by people who are trained in the scholarly use of data, because there's something about learning to ask the question and then going through the whole lifespan where you actually have to figure out what the question is, define ideally a hypothesis or some sort of a priority theory that you're moving forward with, and then actually gather the data, transform it, organize it, do something with it, come to some conclusions analytically, defend it, write it right and then have it sort of out in the public space. There's something about that life cycle that really helps you understand and what I found you know because we've kind of grown up through the data boom.
Speaker 4:I remember being in the early days of Pop Health. We were at a, you know, collaborative with a lot of leading health systems and it was the inaugural Pop Health Collaborative and everyone was sort of bemoaning the lack of data. What are we gonna do? What are we gonna do? Three years later, we were sitting in same rooms you know, essentially the same people saying what are we gonna do with all this data? Now, we have so much, but we can't make sense of it, right, what do you do with it? And it was almost you get what you wished for. So I think honestly and I think we're getting better there's a maturity in the industry.
Speaker 4:But one of the things that I've often heard people do is basically use fancy methods, use new shiny things to kind of absolve them of the basics of data literacy and data integrity. You know and understanding. Like, is this actually a piece of information that's gonna solve my problem? And it has two problems, right One, you end up stalling forever because we don't have data. We don't have data. We don't have data. And I often use the question like what data would you need? Like, do you need the 10 million or the $20 million randomized control trial for 10 years to get you the information you need. Right, we'll never know what do you think's the best thing, so sometimes having sort of data literacy.
Speaker 2:It's like the enemy of the good.
Speaker 4:That's exactly right and sometimes sort of. I find the view of sort of data literacy and data integrity is actually to like let's get off the data beach head right. Let's move over to practically what we know to do and do it because data's not the problem here. And then, on the flip side, you know how do we use the data operationally. Oftentimes people are just expecting more than what it can give. They're asking questions, expecting it to hey, we're gonna predict these completely unpredictable random events and we think sometimes technology's gonna allow us to do that. Like no, no, how about we use data just to come back and say here's a process, are we doing that process, yes or no? Do we think that process is effective, yes or no?
Speaker 4:Some of the very basic sort of apply quality improvement methods, pdsa cycles. A lot of times data becomes an illusion and becomes a distraction. It becomes so big and let's take some little bite-sized pieces often which are right in front of us, organize them well and then kind of work through the life cycle of what we do with it, and I think that's really where the power is.
Speaker 2:So that's like to me. You've described data discipline.
Speaker 4:I think so.
Speaker 2:The rational use of data is really a discipline around data, which so we've had I feel like every episode. Now we talk about shiny objects and to your point right, I remember I mean every decade there's another shiny object in healthcare. So value-based care was the shiny object before that pop health and quality. I mean we could go back right, we could all go back Pop.
Speaker 4:Health is still shiny right.
Speaker 2:It is what's? Yes, but you know what I'm saying, and but I think we don't do a good job on these shiny objects of like what is it really gonna save us, what is it really gonna do with us? And we get distracted by it, and so I really like your statement of the ruthless elimination of fancy.
Speaker 1:Yes, I wanna dive into that.
Speaker 2:It's such a good like. I love these kinds of terms because we get so consultancy, but then these terms are much more provocative.
Speaker 1:It ties in a little bit with your comment a minute ago. The best is the enemy of the good right. So if you're striving for the best, like you said, the $20 million, you know.
Speaker 4:You know, randomized control, trial or some piece of information. That's just unattainable.
Speaker 1:Correct unattainable. So you gotta go with what you have right, yeah, for sure.
Speaker 4:And I think that's where the fun is, and I think you know I always use that as the back end the ruthless elimination of fancy. The front end is acknowledging the endless fascination with fancy, which is a disease, hopefully a curable disease, right, but it's easy and particularly in the payer provider space, like you're always it's easy to identify what the problem is and then it's easy sometimes to say, well, we need this to come in and solve that. And I think you know, as I've been around healthcare and trying to be super practical and efficient, you know, sometimes it's, you know, you see, these band-aids come in in terms of a vendor or a tool or something, and I can see where it fits. But we're gonna spend more time trying to figure out where to match up the inputs and the outputs, get the pipes to really work together, and we're gonna totally miss and take our eye off the ball of really basic operational processes. You know, like 30-day readmissions.
Speaker 4:Obviously it's something that's been going on forever. There's not probably easy answers there, but the question to ask for me is are we doing the things on the payer side, on the provider side, Are we sort of meeting the members, patients where they are, Are we engaging in sort of assessing the needs, and a lot of times I did a lot of data work and sort of fancier stuff to try and find solutions and you end up finding what you know is what you know Like the biggest predictor of future is what's happened before, and if you spend your time on the things you know with the people who have already declared themselves at a sort of high risk level, focus your energy there and guarantee yourself and your team that you're doing the process you think you're doing 100% of the time, or obviously as close as you can in reality to that, and then you can look for fancy solutions, but otherwise we get distracted.
Speaker 3:What do you think our obsession is with the fanciness? Like psychologically, I have ruffles on my sweater. Yeah, that's right.
Speaker 2:I mean really like it's a soft sweater and it's got ruffles, so I mean. I think it's like a cultural obsession with fanci and I'm not a fanci I don't feel like I'm a fancy girl, but-.
Speaker 3:No, I know, but we are obsessed with the fancy, you know what I'm saying, Like we can't take our eye off of it.
Speaker 4:Well, healthcare is really really hard.
Speaker 3:My ruffles.
Speaker 4:Healthcare is hard, right, if you get down to it, you're trying to deliver. You know, obviously, all the things we're trying to deliver right for people and we're trying to do it in a way that keeps the profession happy and allows doctors and other clinicians to be successful and all these things. It's really hard. Sometimes it's a lot more fun to talk about a cool, new, innovative idea and how that's gonna really change things and three years, five years later you realize I guess it really didn't but you sort of moved on, you know, and it's harder to have the discipline to slow down, especially in a honestly, there's a lot of leadership environments, that sort of prize the fancy and celebrate the fancy.
Speaker 4:And if you bring the fancy initiative as opposed to sort of focus on the day in and day out and really reward, like I mean I spend a lot of time saying, okay, let's say you have 50 quality metrics to attain, are you really gonna have 50 initiatives? No, like, you're only allowed to have three, maybe five at the most, right, and hopefully you'll sort of find your way through to impacting the other metrics. But you know you've gotta stay focused, otherwise you have frenzy. Right, you're going in multiple directions, everybody's busy. I think this might lead to burnout right, probably somewhere down the road, and it's harder and takes more discipline to say let's slow down, let's make sure that we're really learning and growing, learning and growing. And we know the urgency of fires that pop up that make that more difficult, but it's a problem.
Speaker 2:We don't have patience. Well, I mean, justin and I are anytime we work well, you probably witnessed this. Like we always have this push and pull with each other about not being too intricate in what we measure right, like I'm always like let's have like domains and then under the domains we'll have like three measures, and then we have this like scorecard and Justin's like can we just get to the brass tacks?
Speaker 3:I love it. Do one thing. We can do one thing, right so?
Speaker 1:how do we need to define the objectives better so that we can be more disciplined, to not try to do too much?
Speaker 4:Yeah Well, I mean the real challenge right, and obviously the elephant in the room is, you know there's regulatory reports, there's public reporting, there's quality, there's all these things where you know you can't just stop and say, oh, we have the luxury of taking a couple of years to grow, but I think it actually takes. It's a huge leadership step right To say we're gonna focus on these core things and we're gonna do these things right. And obviously, depending on where you are in the maturity of your organization, where you are in terms of your relationships with partners and some of those things, you know you may be optimizing and able to optimize more. But you know, if you're newer, if you're younger as an organization, if you're getting things started, you can't do it all. You know that you want to. So you have to be disciplined and I think the messaging is super important. You have to be clear. You know I was trained in the sort of driver diagram classic like let's put the boxes and let's put our you know our structure, process, outcomes, measures and really track them, and I think there's discipline to that. That's beautiful. And then you strip away some of the complexity so that people can know where they anchor in. And I always say there's people that you know.
Speaker 4:I've worked with a lot of different people doctors, clinicians, nurses, mas, people in all different you know leadership levels and some people you just say, hey, we're gonna go do this and you know what?
Speaker 4:Like they run with it, like they just get it right and they just run with it. You don't have to do anything, you just have to like pat pat, applaud, applaud, go, go, go. And there's other people you can have the same conversation. They literally look at you and it took me a while to realize, cause I'm like a vision guy and like, oh, we get it, and then we know what to do. I was like, oh, you just need to know where to put your foot on the ladder, like here's your left foot, it goes right here. So it's really interesting as a leader to be able to recognize you know you've got to be able to meet people where they are and make the message clear and the operational steps clear. And I think you know it's easy to miss those and if you're too operationally focused, people get lost in the weeds. If you're too vision focused, people just think you're out and sort of been never to ever land.
Speaker 1:Yeah, that's yeah great discussion. So we always like to ask.
Speaker 4:Sorry, we're off script.
Speaker 1:No, we're not. No, we're not. No scripting no, and anybody who watches this on, oh yeah.
Speaker 2:Anybody who watches this on video sees this with our notes, and I just want to be clear that, like we tell our guests, we have these scripts just to try and keep us from like, keep us on track. Well, mainly, so we actually talk about the topic because we probably just sit in chit chat.
Speaker 1:We go down too many rabbit holes, but we do. We did ask you and we like to ask all of our guests about buy the world a Coke moment.
Speaker 2:Do you want to sing that for us?
Speaker 1:Teach the world to sing. Okay, so yours hits our topic today of the rational use of data. I think your statement is wind at the back, yeah, so can you?
Speaker 4:yeah, that's become a motto. I don't know how you buy that, you know, but I just believe it in my heart, like I just you know, I guess it's when I've looked at the people I've worked with. I've worked with just great people, like you know, all the way through. I've never seen someone I kind of get laughed at when I say this sometimes Like I've never seen somebody who's just trying to make everybody's day bad, right, and really trying to mess up healthcare right. Everybody, no matter where they are, is trying to do the best they can and it's just so challenging to watch, like as a leader you know in my role when I was actively seeing patients as a doctor, as a leader in the practice, and you know it was just so hard to watch Like the system is literally like putting up barriers.
Speaker 2:So that's you know. It's funny Like a light bulb just went off for me. I'm sure there's like a sound effect for that.
Speaker 1:But wait like no, no, no sound effect, oh why it makes it fun.
Speaker 2:Wow, no, no.
Speaker 1:All right, there's like some kind of jazz thing. I told you I was worried about this, but it makes it so much? More fun. You can't sit next to the machine anymore. Okay, I'll take the applause.
Speaker 2:All right, okay yeah okay. No, I just so. I just the light bulb did go off for me of thinking, when we were preparing for this podcast with you, we talked about the middle of the, and I do want you to go back to the wind piece.
Speaker 2:But let me just say this I was thinking about oh, you've been on the provider side because you worked at Christiana, you were on the delivery side, as kind of that business hat, and then now you're on the payer side. But what I missed in that was the fact that you were also a provider of healthcare as a primary care. So you have like this triple. When we talk about triple aim, it's like you have a triple. It's really interesting. I didn't. So, like I said, the light bulb just went off.
Speaker 4:Yeah, no, and that's. I mean I love that. I love the experiences I've been able to have and, again, having seen people in all these different settings like people are trying to do the right thing, I mean, you know, people are burned out because they know what they want to achieve and they're challenged to achieve it. I used to always use this family circus cartoon at the beginning of all my talks and it was literally like the mommy telling Billy, like go make firewood, and he literally does the Billy thing, or he goes all the way around. I don't know what generation you guys, your demographic is Okay.
Speaker 2:Good, we're speaking family circus. I feel like, though, we're still we're ahead of you, like you're still like a decade younger. I feel like based on your background, I'm like nope, we are clearly.
Speaker 1:That's just an overachiever he is. He's done like twice of what we've done.
Speaker 3:He's not hard. Yeah, we'll get to the less accomplished guests. I, we really do. You're too funny. Well, let me tell the Billy story.
Speaker 4:So I it's like he's Billy's mommy says like let's make a fire, right, and Billy does all this stuff and he goes all the way and he has these adventures that Billy always does and at the end he has a little stick and he holds it up. He's like, is this good? And I use that example to be like you know, everybody in their healthcare space, doesn't matter where you're sitting is Billy Like he's been given a task and he's been super busy, right, he's running through everything. He's the and of course, sometimes you get distracted because you get distracted, right, work and whatever else. At the end of the day, like we know that what we're delivering isn't quite up to what we want to be delivering. Very few people in healthcare can say like I'm super satisfied, you know, across the board, with what we're delivering, and and I think you know that leads to burnout, that leads to all those things that we know right, and and so I use that to say like, man, if we can just start solving not the fancy, not the like, even some of the next generation stuff, I'm sort of a little bit boring in terms of like a leadership stock. I'm like, let's just look at what are the things you're doing today. And you know, if it takes you 12 steps today to go one, what will you feel like? If it only takes you to go six to go one? Right, you literally get half your life back right. And so if you start looking at like, where are our doctors in office is spending time, where are patients sort of getting lost in the system, and you start solving, brick by brick, you know those things, can we make it feel more efficient, even as we're starting to pick up steam? And so I've always been very focused on what are those little things.
Speaker 4:And you talked about value based care. Like you talk to doctors, you know obviously it's different now, but you know, even a few years ago you're talking about value based care. It's like what are you talking about? We didn't have a heavy managed care presence, we didn't have MA and a lot of those things. That sort of mature you into some of those systems and processes. So you're having this conversation like, well, what do you want me to do? Well, we'll hear.
Speaker 4:And when you start talking about what those things are, it's like, okay, I can or I can't do that right, when it was abstract, I couldn't react. When it's concrete, now I can react, can I, or can I? Okay, you need me to do nine things. I can do two, right, great, well, let's start with two and see where we go from there and you, just, you find like you can actually build momentum. And then, as you're doing that, if you're doing it with discipline, you know, then you start to build muscle right and you start to learn.
Speaker 4:Like we're doing this with our team at Delaware First Health right now, like you know, our behavioral health team. We have a little, you know, a group that we're working together looking at all of our behavioral health measures. We're doing it with, you know, epsdt, you know maternal and child health group. And let's look at our measures and what do we know, what are we doing and what do we need to do? And by and large, the obstacles for measures one through seven are the same for obstacles and measures eight through 12. So let's solve it in measure one and solve it well and learn about it, and then we'll sort of work our way through with like you know, a little bit more accelerated momentum.
Speaker 4:Once we kind of built the muscles and we built the teamwork and it's the commitment to the operational teamwork and the commitment to the vision and being systematic and not letting the frenzy and the fancy get in the way, because then people just go in a hundred directions and you don't have as much to show for it at the end and that gets back to little Billy with this piece of wood.
Speaker 3:Like I don't feel really satisfied, but I know I worked hard and that's not a good place to be what I'm appreciating right now, which it's just so profound, like your descriptors, and it's really like something that's bringing me back a couple years, but you're like, as someone who loves analogies, like your descriptors actually are, like bring them all excited.
Speaker 1:Usually does sports, but yeah family circuses money. Did we? So what? Billy brought back a wheelbarrow full of.
Speaker 4:The I would. That's what we want, to be right, we want to do it.
Speaker 1:Yes, I understand, and a truck.
Speaker 2:Interrupting Justin he had like some.
Speaker 3:But there's something that you term you've coined Demilitarizing the middle, and this goes between payers and providers and that kind of areas of commonality.
Speaker 4:I think it's something I used to think about a lot. You know, there's I have some funny sort of patient stories. I won't go into all of them but like as a doctor treating a patient and knowing I want to get them this, like why Does it take this whole process to get that to happen? Right, and you just realize, like on the doctor, I had the patient, we had the objective and it was just hard to get that done for a whole host of reasons. And you know, I just started thinking like wow, what if we, you know, configure how to make those things work Well and how to make them aligned? And you know, I mean I'm a big like Stephen Covey, covey, happy habit number four, like think win-win. And you know, I think that's the fundamentals of value-based care. Right, like there's got to be something here that if we start aligning, start thinking win-win. Sure, there's always gonna be obstacles, there's always gonna be things that are challenging, but I'll bet there's some common ground that we can work towards. And so I think I like to think, you know, that as we Think about that middle ground, I have an order, I have an objective, I have my patient needs, you know, and you work through those processes, we can make sure that the middle, where the, the payer provider interface, where all of the subsequent systems, whether it's DME, providers and all of the sort of ancillary teams that are required, are sort of starting to work in a way that's aligned through and through and we, when you see it, it's like Life-giving right. It's like, oh my gosh, I feel supported.
Speaker 4:I remember the first time I had a care coordinator Like and we, just we. It was like early before everybody talked about it, I had this nurse in my office and we were like symbiotic, like it was like two halves of the same brain, and it was the most Rewarding clinical experience like I've ever had, because I knew she, I was supporting her, she was supporting me, we were supporting our patients and it worked. And when you get glimpses of that and in your health care experience, whatever it is, it can be around utilization management, it can be around discharge planning. It doesn't have to be sort of right in the front and center, you know, around a doctor-patient relationship, but when you see those things getting more efficient, working to support each other, it's better.
Speaker 4:And we have a member right now that needed care and special needs patient had some challenges with the dental system. And where do you find them? And so our case managers are like calling and they're sending these emails just like Celebrating because they talked to the provider, the provider was able to see him, the parents are happy, the kids happy, and it's like so here we are as a payer, but we're like right in there rolling up our sleeves, like jumping for joy that that would remember it and that patient is gonna Get what they need patient centeredness.
Speaker 2:It's unbelievable. Yes, and it's truest.
Speaker 4:That's what it is and it's not a you know the pet. You're getting sort of at the sort of the middle. That's not like that. The providers in the delivery system are trying to do that and the payers aren't. We're all trying to do that Right and we're all trying to support it and those sort of the different tools that we have, the different perspectives we had. I mean, that's why I knew when I was leaving Christiana, that I think I need to work on the payer side. Yeah, I was advised that by some great mentors or I respect dearly.
Speaker 4:Now you have to see you do the other system and I'm so grateful for the experience because I was always told, hey, there's, you know, you have this old like dark side thing and everything. Yeah, exactly, you have your own sort of emotional, visceral response to those kind of things, right. But like now that I've seen, I've always told, no, there's really good people over there doing good work, and I've seen it, right, I know it to be true in the light.
Speaker 2:I've seen it.
Speaker 4:And now it's like how do you get these tectonic plates to like?
Speaker 2:absolutely work.
Speaker 4:It's so much fun and and you see, and now again, the the place is where you go wrong with that, or saying it's perfect. No, no, it's not our problem, right? No, it's all of our problem and it's not perfect. But hey, here's what we can do, here's what we're working towards, and getting back to data discipline and all those kind of things. It's not fancy, it's getting down to some of the basic things of hey, we're doing this, we need you to do this. That doesn't work for you. Do we have options? Oh, guess what? No, we don't right now, but we're working towards them. Great honesty, transparency of communication, interaction, and you can start to build something that you can really take into the future.
Speaker 2:So you, you actually just you, you just, I think, shared kind of your aha moment.
Speaker 1:Oh, yeah, it was like it's almost as if this was scripted.
Speaker 2:It was such a no, but so I can like I know but what I was gonna say is I think he Did like share it so. So I'm gonna ask, now that you have been on both sides right, the dark side and light side Asking they will tell you they're on the light side.
Speaker 4:Yeah, yeah.
Speaker 2:It's funny because the three of us have all been on both sides of the equation.
Speaker 2:I think it's a lot of time doing provider pay or yeah, collaboration and and then before we were consultants because we're not career consultants we, we all have had stents on the provider side and on the payer side, you know, on the business, before the consulting piece really, which I think was really important. But so, can you, can you give an example that now that you're on the health plan side, right that side, mm-hmm, can you, can you share now how you see things a little bit differently From when you were just purely on the provider side, both as a provider of care, from a delivery system, business owner as well as a provider?
Speaker 4:Yeah, you know it's. I mean, I think first thing it actually reinforced to me the belief that I've always had the reason why I went into you know medicine and had a primary care scholarship to sort of commit to that path. It's reinforced the importance of a primary care network and a primary care based delivery system. I mean it's you talk Fancy stuff, you talk all these kind of things. At the end of the day we spend a lot of time on the payer side saying our members need to see you know clinicians who are excellent, right, and and so it's. It hasn't changed my view. It's reaffirmed and reinforced my view of the value of a primary care based system, of a specialty Network that's connected to the primary care team and it's not, you know, gatekeeper and all kind of those integration. It's like the beautiful way that it's supposed to be. And again, you've seen it and tasted it in different places. So you know it's, but it's where a member, a patient, needs to see somebody. They need to see an expert, they need to see someone who can really help them. So that's reinforced my value of that and honestly it's helped me in the new seat to really see, gosh, what the scarcity of access and limitations of access look like for primary care, for behavioral health. So those things that I knew about, those things that I was familiar with From the payer side, you just see them from a little bit of a broader perspective, you start to see why I have this, this membership, and we need to get them, these services, and they either do or don't exist. So how do you now work with collaboration partners? So, again, the value of sort of the delivery system Payers, at least in our experience, and are the way we're structured, aren't the delivery system. So we're supporting the delivery system through all the tools that we have provider incentives, you know value-based contracts, you know member incentives, all these things are really important.
Speaker 4:I think the other thing that was interesting, like you mentioned, the CMI grant. You know that's turned into, like you know, an NCQA certified Care coordination, care management model, right, and, and I so I spent a lot of time with the understanding and I still think it's important of Sort of a delivery system based care coordination program and I think that's key. I think the primary care medical home, in all of its sort of permutations and levels of maturity, is super important. But there's this role that I now appreciate more for sort of what the broader Payer based care coordination system is right and the case management system and and so those things are not. Again, these aren't sort of dichotomy sort of either, or they're both hands right, and I probably had more of a you know this belongs on the provider side kind of mentality.
Speaker 2:Oh, I remember. I mean no, I, and I'm not just joking like. I remember we you and you and others that you were working with at the time you were representative and part of a care management delivery system and you were you were very passionate that, that the provider Kind of owned that and and it's so it's one of the diagrams on your blank.
Speaker 3:That's right. Yeah, it is.
Speaker 2:To hear you say I now understand there's an overlay, that these things, these things fit together. You know.
Speaker 4:You know because we live in a world, I mean right now. You know we started with Medicaid, so you know the company. I work, for a start, as a Medicaid managed care company in Delaware. The parent company is the largest Medicaid provider, you know Centine largest Medicaid provider in the country, largest marketplace and one of the largest Medicare-advanced, particularly the dual eligible population. So you start working, you know, and thinking about, you know, a group of people that are Engaged with and and facing a lot of things on a daily basis, and so you it's.
Speaker 4:I do believe again in a provider-based Care, coordination, care management system. I think there has to be a maturity there, there has to be proactive care, there has to be a, you know, assumption of responsibility. But we also spend a lot of time saying hey, you know, a lot of the members on your list Aren't really engaged with you. So do we want our providers and our delivery systems chasing those people all around or do we want them Taking responsibility for the people that are really under their care and engaged? It's a both and right.
Speaker 4:But you know, to say that that responsibility firmly lies with one or the other Probably not the right answer, because people will fall out of that, particularly people who are not going to have consistent engagement of primary care, people are not going to be consistently engaged in their healthcare all abroad, who are Disproportionately affected and impacted by health related social needs or social determinants of health. So you have to have this backstop and ultimately, you know the pay or serve a function right as a managed care company You're taking. You know, in our case you have federal and state dollars You're responsible for. You're contracted by the state to provide a set of services for a set of members and by golly that's what we're gonna do, you know, and we're gonna put people in the streets to find people who have been lost. People are challenged. Does everybody respond and say, oh, thank you for being here.
Speaker 2:No, right, we know that's not the reality, but you can see why.
Speaker 4:That's a payroll right and then that payroll is can we? Can we move you upstream a little bit or move you Closer to a primary care home where there really is proactive, coordinated care, where those concepts are owned, they're not just talked about and they're financially supported in the appropriate mechanisms right, but I've really just appreciated that, the breadth of the spectrum and, frankly, the breadth of the challenge that we face, right. So I think those are probably two things that I knew about, but I know differently.
Speaker 2:Well, now you really see how they fit together and how they. I hope so.
Speaker 4:I have a vision for it and I know I have team members who were like they're all in right and All in on the provider side, that team that we had there and the team that's still working there. They're all in, right, there, want to do the right thing and our teams all in. So now we got to all.
Speaker 2:Now you can see how they got Awesome so fantastic. Okay, as we wrap up, so sad, but it goes so fast.
Speaker 3:Thank you yes.
Speaker 2:No, we're coming in. Yes, so we always ask. We'd like to always ask if you could leave a legacy in healthcare, what would it be?
Speaker 4:Oh yeah, yeah see leave that one.
Speaker 4:You know it was. It was right after I sort of finished grad school and I was working, christiana and I remember giving a talk and I just felt like I needed to give a bio and and I put I still have the slide. Actually, I sort of put in the upper corner like my own tagline, and it was making Delaware the best place to be a doctor or a patient. And I've struggled with the and slash or and then doctors, should it be clinician and all those things. But you know, what it was back then was make Delaware the best place to be a doctor or a patient. And I I still believe that, not because I'm obviously I love Delaware, multi-generation Delaware. I'm like, I'm really committed to this place and and to the sort of the way healthcare is delivered there. But every grant I ever wrote said this is a microcosm of healthcare in the US. Right, we're not facing any problems that are different. We're just smaller in Delaware and we have some innovative things. We have some things that are lagging behind. We have some, you know, we have all kinds of assets and strengths, just like everybody does. But I really still believe and it's part of the sort of roll up your sleeves and get it done, mentality. And so I've enjoyed the opportunity to really, I think, serve and hopefully leave a legacy positively on the healthcare systems and structures in Delaware on the provider side and I'm certainly learning still and, I hope, positively contributing on now the payer side and I hope those things sort of.
Speaker 4:Again, there's such a big team, there's so many players, but just to be part of that environment, to make a real difference, so that you know, the patients, the members, obviously the ones that we Take care of at Delaware, first health, know that hey, this is we're getting the things done that we need to. We're solving the intransigent problems. We're fighting the good fight, right, we're doing all those things. We're not making it easier, making light of it, but, man, we're solving the problems. We're, when there's a gap, we're finding a way to build it, housing behavioral health, we're starting to solve those things at scale. You know it's a, it is a collaborative effort.
Speaker 4:So anyway, to be part of that still means something to me and obviously I want to do it in a way that's generalizable, that the rest of the country can learn from it. They were sort of in the same fight. Everybody else is and share our little. I always laugh because we'll be on calls with, like Texas in Florida. I'll be like, do you really only have X number of doctors? I'm like, yeah, but think about the opportunity. That is right, you know, and it's and it's fun to be able just to wrap your head around a picture of health care and know that there's, you know, almost a million Delawareans in the mix, right, who, their experience of care and what it looks like at the community level we can make a real difference in, and that's still pretty impactful to me.
Speaker 2:Even after that background, you still have a legacy that it Exceeds like it's. It has the same level of magnitude as what you've already accomplished.
Speaker 1:We're not Not worthy. No, we are not worthy. I can only offer you a brownie.
Speaker 2:And a brownie is all I have on offer.
Speaker 4:Appreciate the opportunity to be with you guys, yeah it's really a lot of congrats on the podcast.
Speaker 2:Thank you, thank you, thank you Well, thanks again. I'm Ellen Brown.
Speaker 3:I'm Dave Pavlik, I'm Justin Politi. We are the partners at BP to health your best chance for real change as you can tell, we can talk about this stuff all day.
Speaker 1:Drop us a line through our site at BP to health comm. This episode is produced by mainline studios.
Speaker 2:Our guest, our guest studio for the day which is. It's been fantastic if anybody needs to. Yeah, anybody needs to record a podcast in the Wilmington Philadelphia area. As we have learned, we like being in person with our guests, so thank you for coming in person.
Speaker 4:Oh man, it's easy for me. I play soccer here, my kids play soccer here all the time, so all right, I'm not a for-right, I'm a podcast coming up All right.
Speaker 1:All right.
Speaker 2:Thanks again. Two o'clock tonight on Tuesday, 11pm on Friday瀬town and eight green candy midnight, freeman's.