Claire Bonaci: You're watching the Microsoft us health and life sciences, confessions of health geeks podcast, a show that offers Industry Insight from the health geeks and Data Freaks of the US health and life sciences industry team. On this episode, Molly McCarthy talks with Dr. Kenneth Kizer, Chief healthcare transformation officer with Atlas Research. And Dr. Shantanu Agrawal, CEO of the National Quality Forum on the recently published report, the care we need, which provides a roadmap to overcome the most critical challenges in healthcare today.
Molly McCarthy: Good afternoon. I'm Molly McCarthy with Microsoft and I'm so excited today to have with me, Dr. Kenneth Kizer from Atlas research and Dr. Shantanu Agrawal from the National Quality Forum. Good afternoon.
Dr. Ken Kizer: Hi Molly, good to be with you.
Dr. Shantanu Agrawal: Hey, Molly. Thanks for having us.
Molly McCarthy: Thank you. I would love to just start off with a simple introduction.
Dr. Ken Kizer: Sure, this is a Kizer. I'm currently a chief healthcare transformation officer with Atlas research. As far as involvement with National Quality Forum, I was the founding president and CEO of the organization in 1999. And was there through 2005. And have interfaced with them periodically in various ways over the years since.
Dr. Shantanu Agrawal: Yeah, I'm Shantanu Agrawal. I'm the current president and CEO of the National Quality Forum. And Molly, thanks again, and it's been great working with Ken on this project and a couple of others. It felt very important and timely to have both of our voices at the table for this.
Molly McCarthy: Alright, well, thank you appreciate the time. I just want to start off with thinking back over the past year and the releases of the report that "The Care We Need: Driving better outcomes for people and communities". As we think of healthcare in 2020, taking a step back maybe and talking a little bit about Dr. Kizer, the purpose of convening the task force, including the drivers back in 2000, versus the drivers today in 2020.
Dr. Ken Kizer: Sure, the things have obviously changed a lot over the past 20 years, and there has been considerable progress made in improving the quality of care and moving the quality agenda. But we're not where we would like to be. And while the landscape has changed a lot, indeed, thinking back in 1999-2000, when the National Quality Forum was established, we were still debating whether you could even measure heatlhcare quality and coming to agreement on what some performance measures would be. So as I said, a lot has changed, but not enough has changed. And so the idea behind the task force was simply to take a look at what has happened over the last 20 years to assess where progress has been made, where progress has not been made, and look over the next decade to see how we could align incentives and come up with a common pathway forward over the next decade.
Molly McCarthy: Great, thank you and Dr. Agrawal, tell me a little bit about as you put together the the task force for this particular report, and thinking about your strategic objectives, I would love to hear a little bit more about you know, what the what the objectives were going forward for the taskforce and actually even talking about the five different subcommittees that put this report together.
Dr. Shantanu Agrawal: Sure. Thank you. So we certainly looked back at all of the work that had been done since 1999. Obviously the Hallmark report 'To Err is Human' from the then IOM, and really started asking the questions what where have we, as a broad ecosystem succeeded? Where have we fallen short to Ken's point. And that was really what led to the idea of convening this taskforce. It was a pretty major effort, I was again, very happy that can could co-chair with me. And we wanted to make sure that it was very diverse in its makeup. So we had nearly 100 individuals and organizations involved that cut across all the major sectors of healthcare and really put forward to them, you know, how do we take what we have learned and the successes that we've achieved over the last 20 years and really work towards a future in 10 years where we normalize, high value, high quality care, that was sort of the phrasing and the aspiration, the goal that really guided this work. And to that end, we tried to structure the taskforce so that it would deal with a lot of the issues that we have noticed over the last 20 years. So there was a committee, for example, focused on in a better integration of measurement with the clinical workflow. That's clearly an issue that we see today. There was another focused on technology and how to better utilize and adopt technology for the purposes of care delivery, but also quality improvement. There was really a committee just also focused on promotion and system change. So you know, we have seen over and over again, efforts like this that lead to good recommendations, but then don't really promulgate those recommendations forward. And so we really wanted to be purposeful about that. There was a fourth committee on payments and policy, you know, a substantive change in the last 20 years has been the connection between quality measurement and reporting with payment policy and the reimbursement structure. So we felt it was important to embody that in the structure of this taskforce and make sure we were thinking about how to better leverage payment policy. And finally, we had a subcommittee focused on consumer and community driven care. And this was to try to capture population based approaches, but also how to better empower and activate consumers in really both being involved in the enterprise, but then also helping to shape it.
Molly McCarthy: Thank you. I appreciate that. That feedback and I obviously I was part of the the task force so I'm aware of all the work that went into it. So appreciate that guidance from National Quality Forum. And as we think about those different five subcommittees, obviously, some of the areas that are top of mind today, I think for for Microsoft, quite frankly. Obviously technology but also the foundational opportunities, specifically related to social determinants of health. So I'm wondering if you can talk either of you can talk a little bit about what you found around social social determinants of health, specifically, thinking about reducing disparities to achieve health equity.
Dr. Shantanu Agrawal: Yeah, I'm happy to get started on that. But please, Ken definitely add.We felt at the launch of the taskforce and throughout the work that addressing social determinants and healthcare disparities was extremely critical. And what's interesting is, obviously, Molly and Ken as you both know, we we executed this work largely in 2019, and had been at prepared the report for release in early 2020, which was well before the COVID-19 pandemic. And if anything, I think we've learned in the course of, of handling this acute issue this pandemic. That's some of the core ideas and principles that are contained in the report. Really has been demonstrated to be important. And again, in the course of the pandemic, we have unfortunately seen how COVID-19 has really affected communities of color have affected certain populations, much more so than others disproportionately. And we see that both in infection rates and unfortunately, even in mortality. So reducing disparities achieving health equity has has taken on an even more critical level, even though we recognize it's important throughout the work of the task force. Some of the things that came out of the task force, as far as specific steps that we should be taking, are focusing on better payment policy. So payment policies that are population base to help address at a population level various social determinants of health to ensure that the payment system is being leveraged appropriately to do that. We talked a lot about creating standard data and intervention approaches so that we are really building an evidence base to address social determinants of health, we're building essentially a foundation of data that can be shared across the healthcare ecosystem. To help address those social determinants in a way, again, that's really germane to a particular population of interest or concern. In fact, I would argue that standardizing quality data is a theme that really runs underneath the entire Task Force and report and that can be leveraged to effectuate changes in a lot of different areas, including social determinants. And finally, last thing I'll just touch on and then turn it over to Ken, is that we also talk a great deal about really cultivating a culturally aligned value driven workforce. And making sure again, that high quality high value care is truly normalized across the system. And here too, I think we were really specific about it being culturally aligned because that is so important to addressing issues like implicit bias and other drivers of healthcare disparity. But Ken you please add to that?
Dr. Ken Kizer: So Shantanu, I would I would certainly agree and underscore everything that you've said. I would just emphasize, though, that while the recommendations and the work of the task force was essentially completed, right prior to the onset of the COVID pandemic, and the release of the report was, has been delayed, but the recommendations, I think, are even more applicable and relevant today than then or at least the what we've seen with the COVID has underscored the importance of addressing the disparities in care and achieving health equity, the realigning our payment models and also, I think the role of time technology and how technology can be used to improve safe and appropriate care. And as we have seen with the COVID, the amazing and in some cases increase and virtual care that has been provided. And going forward, we have to look and more at how we find the right balance of virtual care with in person care what the role of artificial intelligence, what the role of many of the other technologies that are coming on the scene will play in healthcare going forward.
Molly McCarthy: Great. That's, you know, I think that's so critical. During the past few months, I know that we've been extremely busy at Microsoft, really helping organizations weave through the use of virtual health whether it's health bots as a front door for individuals coming into a health system, as well as, as you mentioned, just the increase in virtual visits have skyrocketed. So it's been interesting, I think, for me at Microsoft to see the transformation that's happened in the past three to four months has just been so, so great. One other question I want to ask as we as you move forward with these recommendations out into to the market, you know, implementation and measurement as we look forward to year 2030. What can we expect from a realistic implementation time over the next 10 years thinking short term and then a longer term?
Dr. Ken Kizer: Before touching on that I just want to go back and comment briefly on on the role of technology. I think one of the things that we've certainly learned over the years is that technology is not a panacea to solve all the problems. So really, we have to be quite smart about how we use it and find the right ways the right places to use technology in healthcare delivery. So it actually does improve outcomes and achieves the goals that we would like for it to achieve.
Molly McCarthy : Yeah, no, I am 100%, in agreement with you, I think and you made a good point of how do we strike the balance between those virtual visits versus that in person visit? And I think as we move forward, obviously, providers have become more comfortable with those virtual visits, but there's still a need for that in person. So thank you for that comment. I think it is, you know, a fine balance and I think it will continue to evolve rapidly over the next couple of years with the evolution of technology. And it's not the end all be all by by all means we're, you know, our goal, I think from from our perspective at Microsoft is really to allow clinicians to get back to the bedside to be with their patients, you know, through for example, and being clinical intelligence, etc. So I'm really looking forward to to what is coming ahead for us. So I guess what is coming ahead for us? Where do you see us in the next five to 10 years?
Dr. Ken Kizer: Well, the first thing we have to do is to make people aware of the report and we thank you for this podcast, which is one of the ways that we'll be doing that other events like this but and socialize it and hopefully, we can get people aligned behind the the recommendations that are in the report and then it will be a matter of implementing them. Shantanu, do you want to comment?
Dr. Shantanu Agrawal: Yeah, of course totally agree can and you know, what we tried to do in the course of creating the report executing the work is that while we wanted it to be aspirational, we also wanted it to be something that that with focus and dedication the system could achieve within a decade that was very critical from our standpoint so that the report didn't sit on a shelf. I think to Ken's point, socializing the results, the findings of the report, the recommendations are really important. I also think it's really important to say that, at the outset, some of the recommendations might look really large, they might look difficult to implement. But again, recent experience shows us that things are not always as difficult as they appear. So when we were first finalizing the report, towards the end of 2019, early 2020, there were two basic ideas contained in the report that felt very important to all have us on the task force and felt at that time extremely challenging. The first was really elevating and expanding the use of telehealth in a responsible, purpose driven way that would actually help patients. And the second was expanding licensure transfer ability transferability, so that licensure wouldn't stand in the way of a patient getting access to the care that they needed from the provider that was most appropriate at the right time. those concepts were viewed as very forward looking and perhaps difficult to accomplish in the next five years, perhaps in the next 10 years. And then what we saw was an acute public health need basically push those ideas forward really rapidly. To the point where if I have any concern about the report is that some of the ideas are going to look like they were, you know, that they were already executed on or that they weren't aspirational enough. But I think that shows you with enough focus and dedication, a lot of these ideas that look big picture today are actually extremely achievable and would have demonstrable positive impact for the ecosystem.
Molly McCarthy: Right? Yeah, no, I, that's an interesting point that you bring up. But I think, you know, when we did start out, I remember that discussion around licensure and state to state. So it was very real and challenging at the time, but we like you mentioned an acute crisis, such as COVID-19 has really pushed the boundary and forced that transformation and change. Is there anything else that you either of you want to let our listeners know as we move forward with the report?
Dr. Ken Kizer: I will hope that the dialogue that we've seen going on over the last two weeks will include health and the disparities of health. While we're addressing problems related to policing and other issues, that healthcare as part of that discussion about how we can address the disparities that are widely recognized and clearly have been borne out by the COVID pandemic as well.
Molly McCarthy: I agree with you 100%. What about you, Dr. Agrawal?
Dr. Shantanu Agrawal: Yeah, Ken, I couldn't agree more with the point you just made. It's really important. Thank you for making it. I think Molly In addition, what I would really ask all of us to question is, why would we were so close to being able to implement something like telehealth and other improvements, did it take a pandemic to get us there? What was fundamentally different from the end of 2019, to you know, roughly March of 2020, where we had all of these seemingly insoluble questions around reimbursement, structures for telehealth, or the technology or how patients and clinicians might adopt it that suddenly disappeared nearly in 48 hours. I think that tells us that there's something about the culture and mentality of healthcare that needs to change. Like we need to be much more forward leaning, not necessarily to adopt every new piece of technology or every new solution that comes our way, because certainly there's downside risk to that as well. Right, putting ourselves in a place where structurally, we are asking and answering the right questions in a timely manner. I think that principle underlies a lot of the report and a lot of what the report is asking for our core structural changes, better integration of data, better flow of data, use and evaluation of new technologies to ensure that they're appropriate, patients driving choices, etc. I mean, that's the mentality that I think we have to have so that we don't rely on crises to actually move us forward.
Molly McCarthy: I agree with you and I can't I mean, that that really us leaves us with some some work to do over the next 10 years, if not the next one year. I think we really need to take this and digest it. The care we need driving better health outcomes for people and communities Dr. Kizer and Dr. Agrawal, thank you so much.
Claire Bonaci: Thank you all for watching. Please feel free to leave us questions or comments below and check back soon for more content from the HLS industry team.
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