Creating a New Healthcare

Can design be a determinant of health?

We often think about the quality of the clinical care patients receive in our hospitals, the outcome metrics that determine funding and quality and safety rankings, the readmission rates that tell us how well we’re helping people get healthy and stay that way. But one thing we overlook is the quality, accessibility, and care in the buildings those same patients visit, the parking lots, the cafeterias, the sights, the sounds, the space as a whole. 

Our guest today is an architect who looks at existing and possible solutions through a unique lens: Who was this designed for? Abbie Clary is CannonDesign’s Executive Director of Health for All where she leads strategy at the intersection of design, health equity and systems change. She has spent nearly 30 years impacting the healthcare system most directly across over $5 Billion in healthcare projects, including work with Memorial Sloan Kettering, University of Chicago Medicine, MD Anderson, Fred Hutch, Kaiser Permanente Shirely Ryan AbilityLab and more.

Her perspective that “design is bigger than buildings” is changing healthcare by creating opportunities for health in and around the spaces we as people inhabit in our daily lives. By building in those opportunities on the front end, Abbie believes there will be greater access, better outcomes, and an overall shift in health and wellness for all.

Let’s talk PBM’s. 

What even is a P-B-M? Pharmacy benefit managers have been around since the 1960’s, although back then, they were basically claims processors. Things changed in the 80’s and 90’s following the first iteration of ERISA when employers saw PBMs as potential cost containment strategies. The industry continued to explode until 2007 when CVS acquired Caremark, and now the market is really consolidated into just three major players.

Why does this matter? Well, PBMs control just about everything drug-related in the US these days, and that includes the cost. Given that we have not seen the promised drop in drug prices, Americans and employers are still bearing the burden of this bloated and broken system. 

To unpack how this works and what folks are doing about it, we invited back Shawn Gremminger, the President and CEO of the National Alliance of Healthcare Purchaser Coalitions. His organization works with regional coalitions of employers to help them advance health policy, leverage their collective power, and drive market change.

Ambulatory Surgical Centers (ASCs) have been around in concept for the past fifty years, but their recent explosion has caught the attention of healthcare systems and, frankly, patients. Why?

Today’s guest, Adnan Qureshi, is a Managing Director with the Mergers and Acquisitions practice at Kaufman Hall. He provides strategic advisory services for healthcare providers and investors around the merger or acquisition of ASCs. The benefit he’s seen in partnership with his clients perhaps explains the answer to this question.

The “DNA”, as Adnan puts it, of the ASC is rooted in independent physicians who, as an extension of their practice, saw the benefit of doing lower acuity surgeries in an outpatient setting. As pain management and technology improved over time, the use case also evolved to the point where there are now few specialty areas where uncomplicated surgeries cannot be performed in an ASC. Without the overhead and operating costs of a hospital, ASCs allow for far more transparent pricing, lower costs, greater efficiency, and often better outcomes, all driving towards higher patient satisfaction. And that’s a win we should all be paying attention to.

Adnan Qureshi has over fifteen years of healthcare transaction experience. Prior to joining Kaufman Hall, he was a Director of Development at SCA Health, a subsidiary of Optum/UnitedHealth Group. In that role, Mr. Qureshi led market entry strategy across several geographies, and sourced, structured, and executed ambulatory surgery center acquisitions.

We’ve been talking a lot about healthspan and longevity in our recent episodes, but how do we get there? What changes would it take in the way we practice medicine to move towards a system that helps maintain wellness instead of a system that diagnoses and manages disease?

This is the fundamental challenge that our guest today and her company, Radence, are tackling. Dr. Julie Chen is the Chief Medical Officer at Radence. An integrative internal medicine physician, she and her colleagues at Radence are working to develop a data-backed model of healthcare that identifies the precursors to problems, allowing for proactive intervention and, in many cases, prevention. 

As Dr. Chen says, it will take awhile to amass the data needed to show that spending these resources when a person is well ultimately results in greater health, lower spend, and better longevity, but we have to start somewhere.

Dr. Chen is not just a practicing physician, but an accomplished researcher as well. Her research, at the FDA, NIH, National Cancer Institute, USC, and Mount Sinai, has shaped scientific advancement in precision medicine. As a fellowship-trained integrative internal medicine physician, she developed numerous corporate wellness programs in Silicon Valley focusing on whole-systems approach to healthcare and previously served as Chief Medical Officer at companies such as Human Longevity and Vitagene.

Dr. Daphne Bascom earned a DPhil/PhD in physiological sciences at the University of Oxford, a medical degree at the University of Pittsburgh, and completed fellowship training in microvascular and reconstructive surgery of the head and neck at Oregon Health Sciences University. She has more than two decades of executive leadership across health systems, health technology, and community health. Most recently, she served as Vice President of Population Health at Saint Luke’s Health System in Kansas City.

So, how and why did she leave all of that to pursue lifestyle medicine, a “vegetable-forward” way of life, and a completely different kind of care?

As we’ve heard from many of our guests, for Dr. Bascom, it was personal. Between witnessing her mother’s long and arduous struggle with COPD and helping her father navigate the healthcare system, she recognized that despite her many years of training, her work as a surgeon, and her leadership, she still wasn’t doing the work that got her into medicine in the first place.

She wanted to help people be healthy. Period. 

That deep calling led her to become the Chief Operating Officer of The Vegan Gym, a global digital health platform dedicated to plant-based performance, healthspan, and longevity. She now hosts the Thrive on Plants podcast and is the Founder of The Longevity Lab. As a lifelong believer in equity and inclusion, Dr. Bascom works hard to ensure that this information is accessible to all people, and much of the education she puts together on these topics is available for free on her YouTube channel, @TheVeganGym.