From Patient Care to System Change: Glenn D. Steele Jr., M.D., Ph.D. on the Future of Healthcare

Episode Transcript
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SPEAKER_00 (00:01):
Hey guys, so today this episode of Glow Wild is
brought to you by Noka Organics,a brand that's not just in my
pantry, but in my heart.
When my daughter Parker wasbattling stage 4 cancer, she
literally survived on Nokasmoothie pouches.
And I mean, they were one of theonly things she could keep down.
And now I can't keep them on theshelf at home.

(00:22):
She loves them so much, she hasthem every morning, and
honestly, so do I.
Whether I'm running errands,hitting the trail, or chasing
purpose, Noka I'll see you nexttime.

(01:01):
Try them out.
You might just fall in love likewe did.
Hey guys, welcome back to GlowWild.

(01:42):
and the Steele Institute forHealth Innovation while advising
organizations on how to aligncare, finance, and technology.
At the heart of his mission,like I said, is a simple but
profound idea that healthcareshould deliver the best outcomes
with the least burden onpatients and families.
We all deserve the best and hebelieves that at his core.

(02:03):
Today, we'll explore hisjourney, the risks he's taken,
and the wisdom he wants to passon to the next generation of
leaders in this field.
So please help me welcome Dr.
Glenn D.
Steele Jr.
All right, Glenn, welcome to thepodcast.
I'm really honored to have youhere.
I gave our listeners a goodintro about your history and

(02:26):
what you've accomplished.
I am just so curious andfascinated by your journey.
Can you tell us more about yourentire journey?
I mean, Harvard educated, that'shuge.

SPEAKER_01 (02:38):
Yeah, right.
Well, you know, it's been a longjourney.
journey and it's been a lot offun and one of the great things
about medicine is if you're youknow if you've got credibility
in medicine in one area oranother you can make a lot of
changes during the journey whichis pretty typical of what

(03:00):
happened to me so I took care ofpatients for over 20 years and
that was what I call thehonorable part of my career and
was very gratifying and then Ikind of moved into the
administration and the businessof medicine for the last 20
years.
And that's been equallygratifying.
So there's a huge amount ofopportunity and it's been a lot

(03:27):
of fun.

SPEAKER_00 (03:27):
How long were you in patient care?
24 years.
Okay.
And what gave you theinspiration to switch from
patient care into what you'redoing now?

SPEAKER_01 (03:39):
Well, you know, I I really enjoy working around very
bright people who are extremelyinnovative and sometimes hard to
manage.
It's an acquired taste.
And so when I found out early onin my career that I could

(04:01):
actually coordinate these peopleand we could accomplish great
goals together, I ended uphaving more and more business
opportunities and more And I gotto a point, particularly when I
went to Chicago, where Icouldn't give the kind of care

(04:21):
and couldn't put the attentionon patient care that I was able
to do before I had moreadministrative challenges.
So I had to make a decision, andthat's when I gave up the
caregiving and moved into theadministration and business
aspect.

(04:41):
But I enjoy working aroundpeople who are very innovative,
extraordinarily accomplished,very bright, and hard to manage.

SPEAKER_00 (04:52):
So I hear that you enjoy a challenge.
I mean, it's evident from yourschooling, you know, the patient
care for 24 years, moving intothis new space where you are
facing more challenges andworking with people that might
be difficult to work with butthat inspire you it sounds like

(05:14):
so i am just i am curious aboutthe purpose behind it what fuels
you to work in the space you arenow

SPEAKER_01 (05:24):
Well, again, there's a great deal of gratification in
taking care of human beings andindividual caregiving.
But there's also been hugechallenges and transformation in
healthcare during my time in thefield.
A good example would be actualimprovement in cancer care.

(05:50):
Cancer was my particular area offocus.
And when you think Think aboutthe kinds of mortality figures
that I experienced back in the60s and 70s of the last century.
Leukemias, particularlyleukemias in kids.

(06:10):
When you think about a lot ofthe adult cancers that were
really devastating or in orderto cure somebody, you had to do
devastating surgery ordevastating chemotherapy or what
have you.
The improvements have beenabsolutely remarkable.
And so that's, you know, to beable to be in that area and to

(06:33):
be involved in some of thetransformation is so gratifying.

SPEAKER_00 (06:39):
I can imagine you've had years of experience doing
this and seeing the...
the huge change.
I mean, even speaking with ourchild's oncologist, he said
their mortality rate forchildhood cancer was very high
in the past and it's increasedor decreased significantly,

(06:59):
which is great.
We're moving in the rightdirection.
I know that you're so centeredon the patient and the patient
care.
What could you give people whoare looking for advice on how to
achieve the the patient carethey need or to advocate for
themselves.

SPEAKER_01 (07:18):
Well, I think, you know, I think there's still a
lot of room for improvement.
So, I mean, the balancing act incare is, particularly if you're
giving care to an individual andyou're an individual
practitioner, you want to makesure that the patient and the
families that you're dealingwith feel confident in what

(07:39):
you're doing.
But at the same time, you knowthat there's room for
improvement in almost everyaspect of healthcare delivery.
I mean, There's so much basicscience now that is coming down,
particularly in cancer andcardiovascular disease and
musculoskeletal, all of theprevalent diseases, that the

(08:04):
ability to keep up as anindividual practitioner or as a
patient is almost impossible.
So you have to have asystem-wide way of making sure
that the practitioner knowsexactly what the improvements
are and that the patient isconfident that that practitioner

(08:25):
has a system behind him or herthat really helps them keep up.
And that goes beyond just anindividual practitioner making
as much accountability aspossible and understanding
what's happening in theliterature.

(08:47):
An individual human mind can'tdo that and keep up in a busy
practice.
So there's got to be a systembehind that individual.
And as a patient, you need toknow where to look for the best
system behind an individual,whether it's in heart disease or

(09:08):
musculoskeletal or geneticdisorders or cancer or what have
you.
And that's pretty tough, prettytough to keep up.
You know that.

SPEAKER_00 (09:18):
I absolutely do.
Absolutely do.
I mean, when we were down inSalt Lake with Parker, I had no
idea what information they weregiving me at the time.
You're first in shock, so you'renot really aware and you're just
going to put your trust in thedoctor.
But I do know from my ownmedical experience, you have to
advocate for yourself becausethey kept missing my diagnosis

(09:40):
over and over.
And I love that.
Can you tell us more about thatsystem that you've created?
to help these patients

SPEAKER_01 (09:50):
and these practitioners?

(10:18):
out there, if you're dealingwith something, the first thing
you need to figure out is how toget to a high-trust
organization.
Because you'll never be able tomake all the decisions that have
to be made.
But there are certain giveaways.

(10:39):
So if you go to a high-trustorganization and you've done
your background search, you'vegone on the internet, you
understand And you ask almostany question at all.
You can tell by the response tothat question whether you've got
a good relationship with theindividual in front of you who's
giving you the care or theorganization.

(11:01):
You can pick it up.
And if there's any nervousnesson the part of, you know, the
person who's answering yourquestions, if there's any
defensiveness, you probablyought to look for a different
relationship or a differentorganization.
Yeah, absolutely.
Absolutely.
They're little tip-offs.
But once you have trust in thatorganization– and you can look

(11:23):
at mortality figures.
You can look at outcome figures.
Now, one of the interestingissues is even for so-called
routine care– You've got to kindof go through the same thought
process because you can getscrewed up.
If you go for a so-calledroutine care and things are not

(11:51):
systematically as good as theycould possibly be, you can get
screwed up.
Interesting.
Once things get screwed up, itgets much more complex.

SPEAKER_00 (12:01):
So if you were to give a patient advice in going
in, let's say, They've goteither a cancer diagnosis or,
you know, a very seriousdiagnosis.
What would you give a patient?
I can take that out.
How would you guide your patientin asking the right questions

(12:22):
and what would some of thosequestions be?
Okay.

SPEAKER_01 (12:26):
Well, the first question is if you're told that
you need to have a blood test orif you need to have a certain
x-ray or diagnostic procedure orwhat have you, The first
question to ask is, whatdifference will this make?
If I get a certain result, whatwill that lead to?

SPEAKER_02 (12:48):
And

SPEAKER_01 (12:49):
how will that make a difference in my care?
And that sounds like animpertinent question.
And some people are scared toask the doctor or the nurse
practitioner impertinentquestions.
But there's no question that'simpertinent, basically.

SPEAKER_00 (13:10):
Can we just?
that relationship betweenpatients and doctors.
I feel it.
I know that many people feel it.
We feel beneath the doctor, sowe are afraid to question them.
And what advice would you giveto us in that sense?

SPEAKER_01 (13:27):
Well, first of all, the doctor or the nurse,
practitioner, whomever you'redealing with as a caregiver is
should know more than you know.
I mean, that's number one.
So it's an asymmetricrelationship.
But that doesn't mean that youshould not be able to have
every...

(13:49):
answer that you need to have inorder to make the right
decision.
And some of it is just thefeeling that you've got a good
relationship.
I mean, I suppose if you'rehaving a hip replaced or if
you're having a coronary arterybypassed or whatever, you want

(14:09):
to have a good technician.
You want to have somebody, andeven if they're, you know, on
the spectrum or even if they'rejerks or what have you, you
know, as long as they're thebest technician in the world
okay.
But most of the time in arelationship, whether it's a
primary care relationship orwhether it's a specialty

(14:29):
relationship, a huge amount ofthe ability for you to do well
as a patient is dependent notjust on the expertise of the
individual that you're dealingwith, but also a good, caring
relationship.
And that has to do withchemistry.
It has to do with trust.
So it's a combination of both.

(14:51):
Okay.

SPEAKER_00 (14:52):
Now looking

SPEAKER_01 (14:53):
at...
I mean, when my father had hisheart surgery back in the 1960s,
nobody else, there were twoplaces that were doing coronary
artery bypass.
One was in Cleveland and theother was in Milwaukee.
And so I was just kind ofstarting my career in medicine,

(15:14):
so I was able to get cared forin Cleveland.
And the cardiac surgeon was ajerk a complete jerk but I was
told he had the best hands inthe world so we went there and I
had to be the primary carephysician for my father who said
I don't want this jerk to be butI said do it deal with it but

(15:39):
you shouldn't have to make that

SPEAKER_00 (15:41):
choice anymore right we have so much more access now
and that is just crazy to thinkabout there being two people
doing this, and you're in thebest hands, your father doesn't
like him, how did everythingturn out?
Well, it turned out fine.
Great.
It turned out fine, but itwasn't that optimal experience,
obviously.
I understand that.

SPEAKER_01 (16:00):
And now, because there's so much more expertise
that's more widely distributed,you don't have to deal with

SPEAKER_00 (16:06):
that decision.
That's great advice.
I think that's so important.
Looking back at your entirecareer, what is...
something that stands out foryou that has been the most
impactful, not just for you, butfor the medical industry as a
whole?

SPEAKER_01 (16:26):
Well, you know, there were three leadership
segments in my career.
And the first leadership segmentwas leading a surgical training
group that was part of theHarvard complex.
And the two things that wereimpactful there were had to do
with us leading the way ingetting women involved in

(16:50):
surgical leadership.
So, and this sounds crazy nowlooking back on it, but in the
80s, we were one of the firstreally great surgical training
programs that accepted women.
And over a 10-year period inleading that, 50% of our
graduates were women, and theyall went on, the men and the

(17:12):
women, both went on to createprograms great leadership, but
we, we led the way and actuallyaccepting women into surgical
training.
If you could believe that.
That is great.
Yeah.
And, you know, and it waslooking back on it, it seems
stupid that, you know, that itdidn't happen because the bigger
your denominator is foranything, you know, the better
your numerator is.

(17:34):
But, but back in the day, youknow, just, it was unheard of.
So that was a big change that,that we helped to lead.
The other, the other thing is,In GI cancers, there was just
the beginning of a move awayfrom huge, huge disabling

(17:54):
surgery.
For instance, in colon andrectum cancer, we used to remove
huge areas of the body and haveostomies and colostomies and
what have you.
And over the period of the 70s,80s, and 90s, we actually were

(18:14):
involved, a number of us inleadership positions were
involved in actually modifyingthe kind of therapy that was
necessary to cure people withoutnecessarily causing a huge
amount of disruption to theirbodily function.
So that was very gratifying.

SPEAKER_00 (18:33):
That is.
I have experience with twodifferent ostomies.
They are hard.
They are life-changing.
They are embarrassing.
It's just a constant dailythought, you know, all day long
about what's going to happen.
Where can I go without havingissues?
And so that's huge that you'reable to modify the treatment

(18:57):
there and change people's livesbecause it, it really, it does
affect you and your identity, Ican say.

SPEAKER_01 (19:05):
So the second, the second leadership job was at
University of Chicago where Iwas Dean of Biological Sciences.
And almost everything I triedthere failed.
So we tried to change thecurriculum of the medical
school.
It didn't work.
I mean, there was cultural andregulatory issues, and it was

(19:26):
just impossible.
The second thing we tried to dothere, and when I say we, there
were three or four of us thatkind of traveled together from
Boston to Chicago and then toPennsylvania.
We tried to create a businessmodel where instead of having
what's called a deep means dowrywhere you negotiate for a lot of

(19:46):
resource and then you use it upand then you renegotiate.
We tried to actually create asustainable business model.
That didn't work either.
But I learned an awful lot.
It was a great group of people Iworked with, some of the
brightest people in the world atUniversity of Chicago, both on
the clinical side and on thebasic side.

(20:07):
But almost nothing that I triedthere actually worked.
So I learned a lot from that.
And then the third segment wasthis really interesting place
called Geisinger Health System,which was in the middle of rural
Pennsylvania.
And there we actuallytransformed the relationship

(20:29):
between the insurer and theprovider.
We had both an insurance companyand a large provider group with
hospitals and outpatientfacilities and what have you in
the same fiduciary.
And back in the day, and thiswas back even in the 2000s,

(20:51):
there was an enmity between thepayer side and the provider
side.
They would battle each other.
The providers wanted to get paidmore for all the work they did,
and the payers wanted to pay theproviders less.
That's tough.
That's kind of the way it was.

(21:12):
Yeah.
And what we did at Geisinger,which was transformative, was to
say, is there a way of havingthe payer side, the insurance
company side, and the providerside actually working together
to the mutual benefit of theconstituencies?
Because a huge number of ourpatients were also people that

(21:34):
we provided insurance for.
And that began, you know, awhole national experiment on
what's called value-based careas a to fee for service.
And it meant that the insuranceand the providers were actually
trying to do better for patientsto decrease the total cost of

(21:56):
care and keep people withchronic disease, because we had
a huge old population with atremendous amount of chronic
disease.
And in rural Pennsylvania, itwas Appalachia, basically.
Keep them in better shape andkeep them out of the hospital.
So we would save money.
They would And our insurancecompany would actually do
better.

(22:16):
And then the insurance companycould transfer part of that
financial benefit over to theprovider.
So it was transformative.
And it started a series ofnational experiments called
accountable care organizationsand what have you that have been
trying to scale that.
And it also started themovement, which is now, you

(22:39):
know, continued with Medicareand with Medicaid programs.
And a lot of commercialinsurance as well to be paying
people for outcome rather thanjust units of work.
So that was very gratifying.

SPEAKER_02 (22:54):
I can

SPEAKER_01 (22:54):
see that.
Those are the three components.
So two out of three were reallyinteresting.
One was a dud, but I learned alot from the dud.
So

SPEAKER_00 (23:02):
I want to talk about that.
Tell me more about yourchallenges that you've had
through this whole process andany failures that you look back
and say, I learned a lot.
We just spoke about one.
You learned a lot.
Tell us more about that.

SPEAKER_01 (23:20):
Yeah, well, you know, I think if you achieve a
lot in life, you also fail alot.
And your aspirations, if youraspirations are very, very high,
you generally never achievethose aspirations.

(23:41):
Most people don't know that.
You know, my kids don't know howmuch I failed because I've
really achieved a lot.
I've been very lucky.
But you're always, you know,you're always stretching.
And, you know, you have tofigure out how to deal with
failure but you accomplish a lotas well and a lot of it

(24:08):
particularly in ruralPennsylvania when I went to
Geisinger they were just comingoff of a three year failed
merger with Penn State, HersheyPenn State and everybody the
morale was really low it hadbeen a disastrous marriage and

(24:30):
the people, you know, had greatengine size, great engine size.
And what, you know, what wasreally gratifying was if we set
ambitions that were very high,there were things we could do at
Geisinger that other reallygreat institutions couldn't do
because we had a huge patientpopulation that loved us on both

(24:52):
the insurance side and theprovider side.
But setting goals very high andhaving the individual people who
had been beaten down with threeyears of an unsuccessful merger
and watching them actuallyaccomplish a huge amount and

(25:13):
having everybody realize over aperiod of time that they weren't
limited by their engine size ortheir capabilities.
They were just limited by theiraspirations.
And if you could get groupaspirations moving together, it
was amazing what could beaccomplished.

SPEAKER_00 (25:29):
Yeah, team powers is so extraordinary.
What advice would you give topeople who have these high
aspirations, but they fail onceand they just give up?

SPEAKER_01 (25:44):
Yeah, well, a lot of it, you know, is personality and
a lot of it's just resilience.
And, you know, some people haveit and some people don't.
But I find that, you know, Ifound certainly in, well, in
Boston it was different becauseeverybody thought the world was
perfect.
And, you know, if you made anychange at all in Boston, people
worry that you would screwthings up because everything was

(26:06):
already perfect.
Oh, got it.
Yeah.
You know, that's hard to workwith.
Yeah.
But certainly in, you know, inPennsylvania where we created a
national and an internationalmodel for, you know, for
value-based care and, you know,for how the payer and the
provider could work together,you know, I just found that if

(26:30):
you could create initial successin certain areas and celebrate
it, then the group wouldrespond.
And some of the people, youknow, wouldn't respond.
Some people are just negative nomatter what.
You know, it could be genetics.
It could be, you know, earlyenvironmental issues, who knows

(26:51):
what.
But, you know, what we were ableto do was, you know, either
change their minds or replacetheir minds, one of the two.
Yeah.
And then it built up a lot ofmomentum.
So individuals have anincredible capacity to do really
great things or really badthings.

(27:12):
And a lot of that is influencedby leadership and is influenced
by the environment.
Right.
I mean, it's amazing theplasticity of human
capabilities, either on the goodside or the bad side.

SPEAKER_00 (27:26):
I agree.
So you've been around the block.
Do you mind sharing your agewith us?
You know, I'm 81.
81, and you are still working.
Do you see yourself ever fullyretiring, or because this is
such purposeful work for you, doyou see yourself just going and

(27:47):
going until you can't?

SPEAKER_01 (27:50):
Well, you know, everybody builds up a reputation
and what have you, and I'm stillrunning on the reputation, and
so I still haven't brand.
Um, and so, you know, I'm stillasked to be a part of, of a
number of organizations, uh, andI can pick and choose now.

(28:10):
That's nice.
I mean, you know, living inJackson hole ain't all bad.
Um, and luckily, you know, westarted here in 1969.
So I was able to ride, you know,ride this obscene equity
increase up.
Right.
Uh, and, uh, and, and it's been,it's been great.
Um, and i can pick theorganizations that i want to be

(28:33):
a part of the organizations haveto be you know have to be
consistent with my missionbasically most of them are
trying to do transformativethings some success some failure
and i pick the people that iwant to be around i i enjoy
being around interestingchance-taking people um and i'm

(28:56):
still learning i you know i ithink I think that my attention
span is relatively short, soevery one of these leadership
jobs was between 10 and 15years, and then I got a new
learning curve, and I'm still ona learning curve.
My learning curve now is privateequity, venture capital, a lot

(29:17):
of startup stuff, which isreally kind of chancy, but I'm
not in it for the money now.
I'm in it for the mission.
It's fun.
It's

SPEAKER_00 (29:31):
fun.
Right.
I keep drilling into you guys,you listeners, that you've got
to keep going no matter what.
If you fail, get back up.
And you're right.
It does kind of come down to thepersonality type of the person.
But to see someone who has beensuccessful for so long, has

(29:51):
their brand, has the name.
Can we talk about your personallife and how that worked
together with your professionallife?
You You have two daughters and awife of how many years now?

SPEAKER_01 (30:02):
47.
47

SPEAKER_00 (30:04):
years.
She's my second wife, too, sogive me credit for that.
I didn't know that.
Okay.
I'm learning something new aboutyou all the time.
Well,

SPEAKER_01 (30:13):
yeah.
Well, my son, you know, my son,Josh.
Oh, right.
So you have three kids.
Yeah.
He came from my first wife.
That's right.
That was at Mulligan.
And that was in a time when Isacrificed all things personal
for my professional life.
So that was a learning curve,too.
I mean, that was a learningcurve.
I was a real jerk.
And so I learned from that.

SPEAKER_00 (30:34):
And tell us what you learned and how you brought that
into your relationship with yourcurrent wife.

SPEAKER_01 (30:41):
Well, you know, I just...
you know, balance in life backin the 70s and 80s, if you were
going into leadership inhealthcare, was a joke.
In fact, I can remember one ofthe places that I was thinking
about doing my surgical trainingin, which was Columbia PNS in

(31:01):
New York, would not evenconsider you as a potential
surgical resident if you wereconsidering getting married.
Wow.
They wouldn't consider you.
And the women, forget about it,they wouldn't consider any
women.
But they expect you to go intothe hospital at the beginning of
your residency training and staythere until the end, which is

(31:23):
usually five or six years later.
So there was a lot of socialaffirmation of, you know, no
balance in life.
So a huge amount changedsocially, obviously.
And as I mentioned before, wewere a part of that with
accepting women and, you know,having 50% women in our surgical
training program at Harvard,which was incredible.

(31:45):
But I learned a lot as well.
And once you've had a failure,and my first marriage was a
failure, not because of my firstwife, but because of me, and
you've had a child and you're nolonger with that child, it
affects you emotionally.
And so the second time with Lisawas different.

(32:09):
And we've been a greatpartnering team.
And I got to tell you that forall three of my leadership jobs,
they were not just my job, butthey were our job.
I could not have done my jobwithout Lisa's participation as
a part of that leadership team,a huge amount of business

(32:29):
socializing.
And most of the jobs that I'vedone, not so much Chicago, but
certainly in Boston and in ruralPennsylvania, in Geisinger, not
Most of the people that I workwith who were key members of the
team enjoyed each other, notjust professionally, but

(32:51):
personally.
So it really, it was kind of,and everybody has a different
style in terms of leadership,but we really got close to
people.
And I could not have done thatalone.
That was because of me andmainly because of Lisa.

SPEAKER_00 (33:04):
That's great to have such support in the career.
And I want to know, I know thatboth of your children are, or
all three of them, three of yourchildren are very successful.
What do you think that youpassed on?
Was it through words or reallythrough action that inspired
them to become so successful inwhat they're doing?

SPEAKER_01 (33:26):
No, I don't think it was words.
I think they, first of all, youknow, I believe in genes.
So, you know, the genetics weregood.
On both, you know, both mymarriages, it was terrific.
And then, you know, and then thekids, you know, the kids saw a
lot of success around them andthey saw high aspirations, they

(33:48):
probably weren't as aware of thefailures as, you know, because I
would hide the failures.

SPEAKER_00 (33:56):
Do you think that was to their detriment or to
their benefit?
Because, you know, it does takethat failure because, you know,
climbing to success is not astraight shot up.
You know, you peak, you valley,you go down, you go back up.

SPEAKER_01 (34:12):
I think they're they were subconsciously aware of
some of the failures, but Imean, you know, I've had a
pretty blessed career and, youknow, so I don't think they were
aware of the failures, but theywere chance takers.
And I was a chance taker.
Lisa was, my wife is a realchance.
I mean, could you imagine movingfrom Chicago to rural

(34:36):
Pennsylvania?
Could you imagine that?
I figured if I could recruit herto that, you know, that high
chance, stakes deal.
I could recruit anybody.
So the kids saw us.
They saw us do really well inBoston, which is a great place.
They saw us do seemingly verywell for the six to seven years

(34:56):
I was in Chicago.
They went to lab school and whathave you.
It was great.
And then they actually saw us dowell in rural Pennsylvania.
So I think they must have atleast limbically understood that
no matter where you are, ifyou've got the right aspirations
and you've got the right grouparound you, you can enjoy

(35:17):
yourself and do well.
And of course, the backbone tothe entire family trajectory was
Jackson Hole.
So that wasn't bad either.
Not bad at all.
It is beautiful here.
The kids learned to ski here.
It took us like 30 years beforewe realized how wonderful the
summer was here.

(35:37):
As you know, we would alwayscome out in the winter and never
come out in the summer.
And And then we suddenlydiscover, wait a minute, the
summer is really pretty goodtoo.
It's wonderful

SPEAKER_00 (35:46):
here.
I will say, I've known you for along time.
I vividly remember almost everysingle dinner that we would
have.
And I really got excited becausemy parents...
They're great people.

(36:32):
have inspired me as well.
Those dinner conversations werealways deeper than I was used
to, and I really appreciatedthat.

SPEAKER_01 (36:42):
Well, it's nice to hear.
I don't like to talk aboutmyself, as I told you before we
did this podcast.
I enjoy doing things.
I'd enjoy the change in how wetrain surgical residents.
When I was in Boston, I enjoyedtrying to change the medical

(37:04):
school curriculum at Chicago andthe business model there.
I really enjoyed creating a newmodel of how insurance companies
and providers work.
So I enjoy real lifeexperiments.
I love people who are operators,who are successful operators,
particularly if they'reoperating in systems that are

(37:27):
under a huge amount of challengeand have to change.
And so I don't like topontificate about things.
I don't like to writecommentary.
I like to do things.
So even this is a little bit,you know, it's a little bit
anxiety producing because Idon't like to talk about myself.

SPEAKER_00 (37:45):
I understand.
It's very hard to talk aboutyourself, but I love that you
are just driven by helpingothers and serving a purpose.
And that's huge.
I see here, we're sitting inyour beautiful office and your
beautiful home.
You read a lot.
So have you read any books, andI know this comes up a lot in

(38:05):
all the books I read, is you arewho you surround yourself with.
So it sounds like you like tosurround yourself with doers and
really smart people that arechanging the world.
Do you think that's really true?
And what advice would you giveto people that maybe have these
relationships that aren'tserving them and how to get rid
of them?

SPEAKER_01 (38:26):
Well, I think you have to enjoy yourself.
You really do.
And I can't tell you how manypeople during the 24-year I was
taking care of cancer patients,would come to my office and say,
you know, I was waiting until Iretired until I, you know, and
then I could really do some funstuff with my family and my
wife.
And then all of a sudden they'relooking at, you know, some

(38:48):
terrible physical challenge.

SPEAKER_03 (38:50):
So I

SPEAKER_01 (38:51):
don't think you should wait.
I really do think you need toenjoy yourself and have fun.
And enjoying yourself does notnecessarily mean, at least for
me, does not mean, you giggling24 hours a day, seven days a
week.
It means having stress,achieving goals, failing, being
resilient, what have you, butreally having meaningful

(39:14):
relationships and enjoyingyourself along the way because
you never know when it's goingto end.

SPEAKER_00 (39:19):
I know.
You never know.
I recently listened to a podcastfrom one of my favorite
podcasters, Ed Milet, and it wastitled QTR, Quality Time
Remaining.
It doesn't mean the years thatyou have Thank you so much.

SPEAKER_01 (39:58):
Well, you know, again, I don't look backwards,
you know, except for somethinglike this podcast.
I'm always looking forward.
Now, when you're 81, you know,you're not going to buy wine.
It takes 20 years to mature.
So you've got to be realistic.
You don't want to be delusional.
But I'm always looking forward.

(40:19):
And so I'm always trying tolearn.
And, you know, again, I just–I'm addicted to stress.
I'm still addicted to stress.
Some people are less addicted tostress.
They're probably more normalthan I am.
But I look for organizationsthat are stressing themselves to

(40:43):
try to change, to try to changethe environment around them,
what have you.
So everybody's got a differentset of inputs that turn them on
and keep them motivated.
And you just, you know, again,you just have to use those
inputs.
I think a lot of, you know, alot of, you know, I have a close

(41:04):
circle of friends, some of whomare here physically, a lot of
whom are, you know, in otherparts of the country because of
my networking and what have you.
And I'm still, you know, I'mstill interactive with them.
I'm acutely aware of the factthat at 81 years of age, a lot

(41:25):
of my values and a lot of thethings that I've experienced are
no longer meaningful to youngerpeople who I'm around.
So I try to listen to youngerpeople and learn from them, even
though it occasionally makes menervous and aggravated.
I get that.
I mean, you know,

SPEAKER_00 (41:44):
it's just the way it is, right?
I love to hear that.
Something I keep hearing in ourconversation is that you love to
learn.
Can you tell our listeners howimportant it is, in your
opinion, to continue to learnbecause I know a lot of us stop.
It's critical.
I agree.
And if

SPEAKER_01 (42:02):
you're not in the game, you know, at my age, I've
got a lot of, you know, I've gota lot of depreciating assets,
you know, because people that Iknew who were leading
organizations are either nowdead or insensate.
But that's a joke.
But, you know, they're retired.

SPEAKER_00 (42:22):
And

SPEAKER_01 (42:24):
when they get out of the game, if they're out of the
because they choose to be out ofthe game.
The change in terms of vitalityand robustness and what have
you, it occurs very quickly.
So I think, and if you're in thegame, you've got to be positive.

(42:45):
If you're in the game, no matterwhat your age is, and if you're
negative about responding to allthe challenges, I mean, there's
never been a time in myleadership career there hasn't
been a challenge

SPEAKER_02 (42:58):
And

SPEAKER_01 (42:59):
most of the time, those challenges are viewed by
the people who are meeting themas, this is the worst challenge,
the biggest challenge in theworld ever.
But that's not the case.
And so now we have a huge numberof challenges, both domestically
and internationally.
But if you get to the pointwhere you just don't think those

(43:20):
challenges could lead tosomething better, then you've
got to get out of the game.
And if you get out of the game,then I've just seen over and
over again a lot of quickdisintegration.

SPEAKER_00 (43:37):
That is such a great message, not just in your field,
but for everyone.
Any field.
Everywhere.
Just personally, if you don'tthink that these challenges can
be solved, fixed or can bebetter, then you're not going to
get anywhere and you're right.
You need to step back and letsomeone else figure it out or

(43:59):
whatever it may be.
I want to go back, think aboutyour life as a whole.
What do you think your best,what was the best advice someone
ever gave to you that sticksout?

SPEAKER_01 (44:14):
Um, Well, I can remember having some real...
emotional challenges when I wasin the middle of my residency
training.
And then making decisions toleave the residency for almost

(44:39):
three years and get what wascomparable to a PhD in
microbiology.
So I left the country and wentto Sweden in the 70s and then I
came back to finish myresidency.
And And I almost left myresidency and almost went into
another field in healthcare.

(45:00):
But, you know, and I got advicefrom a lot of people.
And I had a lot of mentors who,you know, who I looked up to
over the years.
And I think the best kind ofthroughput theme of advice is
enjoy yourself.

(45:21):
If you're going to go into afield of, number one, just make
sure you're enjoying it as youstruggle.
And then, again, personalitiesare different.
And I was either geneticallypredisposed or I had a lot of

(45:42):
support around me to takechances.
I took a lot of chances inchanging my career path.
Wow.
Yeah, you have.
But I've always enjoyed whatI've done.
And again, it's not giggling 24hours, seven days a week.
You're kidding me.
You don't giggle all day long?

(46:03):
No.
I mean, a lot of it's stressful,but your basic fundamental
feeling is to enjoy yourselfalong the pathway, don't Don't
wait till some time in thefuture to enjoy yourself and
saying, I'm just going to grindthis out until I get to
retirement or until I get to my50s or whatever.

(46:26):
You have to enjoy yourself.
And again, for me, enjoying isto some extent self-induced
stress.
I enjoy stress.

SPEAKER_00 (46:35):
I'd like to talk about that a little more.
It was my next question.
You had mentioned, I don't knowif you said I'm addicted to
stress or I thrive in stress.
But what do you think is behindthat?
Probably genetics.

SPEAKER_01 (46:49):
I mean, I don't know.
I mean, you know, I just...
And some people have accused meduring some of my leadership of
inducing stress too.
Uh-oh.
Yeah.
But, you know, again, you know,if you have a certain kind of
personality and you're, youknow, you're aspirational and,

(47:10):
you know, you set your goals sothat you're really achieving a
lot but you never quite achieveyour goals, that, you know, that
just, again, but that'ssomething that can't be
generalized.
I understand that.
Everybody has a differentpersonality.
and I'm not making valuejudgments about

SPEAKER_00 (47:26):
that.
No, no, no.
I don't know if you know, and Imentioned this in another
podcast I did recently, butSteve Jobs said, I don't know if
it was in a speech or something,he wrote, if we aren't
constantly stressed, we aregoing to be taken over.
We have to worry, not worryconstantly, but we always have
to make sure that we don't justglide through.

(47:48):
Because we're so successful now,we need to make sure that we
feel that anxiety of maybelosing.
So I don't know if thatresonates

SPEAKER_01 (47:57):
with you.
No, I agree with that 100%.
But again, you have to caveatthat a little bit because how
many people can be Steve Jobs,right?
Oh, I get it.
Yeah.
So when Steve Jobs says that orwhen I say I'm addicted to
stress, a lot of that cannot begeneralized to everyone.
Everybody has a differentpersonality and everybody...

(48:19):
But there is a theme.
You do have to...
You have to feel good aboutwhere you are in life because
you just don't know what's goingto happen tomorrow.

SPEAKER_00 (48:29):
Right.
And we don't want it to be badstress.
Like, if you're in a bad placein life...
you know, maybe that stresswould be something.
You've got to change.

SPEAKER_01 (48:39):
And some people, and again, you know, 99% of
accomplishment in life, whetherit's personal accomplishment or
group accomplishment is notlimited by the engine size.
I mean, most people, you know,have a pretty good engine size.
It's just that, you know,they're not, you know, their RPM

(49:00):
isn't high enough for variousreasons.
And most of the time it'sbecause, you know, They're
nervous about

SPEAKER_00 (49:08):
change.
Yeah.
I mean, change is scary foreveryone.
And what you've done is take thechances, change.
I know you're veryuncomfortable.
I can see it talking aboutyourself here today.
But you're doing really well,and I really love it.
I see, again, that you read alot.
Is there a book that stands outfor you that would be helpful to

(49:28):
people who maybe– in achallenging place in their lives
and they need that, you know,guidance to change.

SPEAKER_01 (49:38):
No, I mean, I read so many books and I'm always
reading a couple of books at onetime.
And so the, you know, whathappens is the latest book I've
read is top of mind.

SPEAKER_00 (49:50):
Yes.
So I

SPEAKER_01 (49:50):
wouldn't.

SPEAKER_00 (49:51):
Okay.
So what are you reading rightnow?

SPEAKER_01 (49:54):
Well, I'm reading a book that's called, or I just
read a book, which is calledEverything is Predictable.
Oh, I haven't heard of this one.

(50:19):
Tell me more.
happens and you change yourfundamental proposition and
there are various mathematicalformulas to show.

(50:41):
But what it means is you takeaccount of all the things that
are happening and then youchange your formulation.
And I think most of life isBayesian statistics.
I mean, if whatever is happeningaround you, you input and then
you create a different set ofaspirations and a different
statistical model So, I mean,that's all BS, but you know, I'm

(51:05):
just, I'm into

SPEAKER_00 (51:05):
it.
I'm interested in it.
So I'm going to check it out.
It sounds interesting.
It's called everything ispredictable.
Okay.
I love it.
Yeah.
So when you look back kind of onthis big legacy that you've
left, what do you hope continuesto happen in your absence?

SPEAKER_01 (51:26):
Well, let me be concrete.
Um, Pre-Obamacare, there were 60million, approximately 60
million people who are uninsuredin this country.
And, you know, through theexpansion of Medicaid and
through the Obama networks andwhat have you, we got that down

(51:47):
to 15 million.
Wow.
Mm-hmm.

(52:30):
as if you can have some sort ofa longitudinal relationship with
the primary care and then theexpertise that you need with
specialty care.
So my argument was we're takingcare of people regardless of
whether they have insurance ornot.
The ones that don't haveinsurance are getting worse
care.
And guess what?
Those of us who have insuranceare paying for it anyway.

(52:52):
Absolutely.
Yeah, we are.
So...
Now with the new bill that camethrough, there's some evidence
that we're going to expand,again, the number of people who
are uninsured.
So what I'd like to do is to seean evolution towards everybody

(53:14):
in this country having somecoverage.
Not because of the ethics.
I mean, I happen to believe thatethically that should happen,
but just in terms of theeconomics of it.
Because I'm paying for it anywayand so I soon have that
efficient so I don't have to payas much.
I mean, you know, just make thefinancial argument.

(53:35):
So I think that's number one.
Number two, I'd like to see acontinued evolution to paying
for outcome.
I'll give you an example.
So for chemotherapy, forinstance, for lots of kinds of
cancer, you know, you give thedrug to a hundred people it

(53:58):
works in fifteen people and allhundred pay for the drug

SPEAKER_00 (54:02):
right yeah that's a good point that's the way it's
socialized

SPEAKER_01 (54:06):
that's the way it's socialized what I'd love to see
is an evolution towards you onlypay if it works oh I

SPEAKER_00 (54:15):
never even considered that that would be
great I mean you're paying foressentially a service so and the
pharmaceutical

SPEAKER_01 (54:22):
companies make less money but trust me they make
enough money Yeah.
They're doing okay.
Yeah.
They're doing okay.
The other thing I'd like to seeis that insurance providers,
whether they're Medicare orMedicaid, the public payer,
whether they're commercialinsurance providers, get closer
to the providers in workingtogether to increase the

(54:49):
efficiency and increase thecaregiving outcome for chronic
disease.
Yeah.
We have a huge amount of chronicdisease in this country, and I
don't think RFK Jr.
is going to fix it.

SPEAKER_00 (55:01):
I was just about to ask you.
I didn't want to get too

SPEAKER_01 (55:04):
political.
No, no.
But we do have a huge amount ofchronic disease, and it's due to
lots of different things thatare out there.
And I don't think there's like abad actor who's putting poison
in that.
Some of it is toxic and some ofit is weak.
But there's a huge amount ofimprovement in chronic disease.
Now, the GLP-1 agonists Right.

(55:55):
to outcome-based care andoutcome-based payment and
value-based care.
So I'd like to see thatcontinue.
And I guess I'd like to see theability of more caregivers in
different areas, not just docs,but nurse practitioners and

(56:16):
psychologists and other kinds ofcaregivers so that there's a
better supply of people who cangive care for not just physical
diseases but emotional diseasesas well because there's a huge
lack of resource for people whohave behavioral issues.

(56:37):
Absolutely.
That's actually one of thecompanies that I'm working with
now.
That's great.
So again, there's just a load ofopportunity out there, a huge
amount of opportunity.

SPEAKER_00 (56:47):
How do you think we will recover and how long do you
think it will take from all thecuts to Medicare happening right
now to going back to thatnumber?
You said$60 million wereinsured, and we're going to go
down to about$15 million.
And

SPEAKER_01 (57:04):
now we're projected over the next 10 years to
increase by$17 to$20 million.
Well, look, in a democracy,things are messy, right?
Right.
And so we may have to wait foranother three to four years to

(57:25):
change.
And again, the good thing abouta democracy is people get what
they want.
The bad thing is things changeand they go back and forth.
So we'll have to wait and see.

SPEAKER_00 (57:36):
Yeah.
It's too bad there's not just atrajectory towards, especially
in healthcare, the benefit ofthe patient like you're talking
about.
But it sounds like you're doinga lot of work with that.

SPEAKER_01 (57:50):
I've had the pleasure of turning down...
positions in the governmentunder Obama I, Obama II, and
Trump I.

SPEAKER_00 (58:02):
No

SPEAKER_01 (58:02):
way.
Tell me more.
So, no, I just knew myself wellenough to realize that I would
probably be an HR nightmareafter a long weekend, regardless
of whom I worked

SPEAKER_00 (58:15):
for.

SPEAKER_01 (58:15):
Absolutely.
I can see that

SPEAKER_00 (58:17):
being pretty intense.
Okay, so you mentioned GLP-1s.
Have you done much research onthem?
How do you feel about them beingso widely used now?
And these are drugs like Ozempicor Wagovi.
Well, the

SPEAKER_01 (58:31):
ones

SPEAKER_00 (58:31):
that

SPEAKER_01 (58:31):
are really going to be revolutionary are the pills
that are coming out.
There are a couple of companies,including Lilly, that have
finished clinical trials showingthat instead of having
injections, you can take pills.
And there's going to be twoprobably that come through the
FDA in the next year.
And when people can take a pilland lose 12% to 20%.

(58:57):
That will really berevolutionary.
So I think there's two or threedifferent levels.
Number one, I think there's somany obesity-related chronic
diseases.

SPEAKER_00 (59:10):
Yeah, there are.
It's not

SPEAKER_01 (59:11):
just diabetes, but it's heart disease, it's
hypertension, it's kidneydisease, you name it, it's
incredible.
So I think there's a hugeopportunity to make a big effect
on chronic disease.
The second thing is the cost.

SPEAKER_00 (59:27):
Yeah.

SPEAKER_01 (59:28):
And the more product that they have out there, the
more competition and the costswill go down, particularly if
and when we start to getgenerics and biosimilars and
what have you.
Right.
And I think capitalism is a wayof putting pressure on the
companies to get the costs down.
That's a really good point,yeah.

(59:49):
Yeah, and a combination ofregulatory and capitalism.
And the third thing, which isalways troublesome, is most of
these things that have aneffect.
And now they're combinations ofGLP-1 agonists and there are
other kinds of physiologiceffects that are being built
into new regimens to take careof obesity and diabetes.

(01:00:16):
You know, these things have tobe taken forever, right?
Yeah.
So there's a little bit of worrythat I have that there could be
other effects that come up overa period of time.
So the idea, as far as I'mconcerned, would be if people
could take these for a period oftime, lose weight, and then

(01:00:39):
change their activity level sothat the calories in are more
balanced with the calories outso that they don't have to take
these pills or take subcutaneousinjections forever.
Because I worry about thelong-term effects.

SPEAKER_00 (01:00:55):
Do you?
And we don't know what they areyet.
We don't know what they are.
They haven't been around longenough.

SPEAKER_01 (01:00:58):
Yeah, exactly, exactly.
But I think they are now being,I mean, it's revolutionary, but
I think as soon as there's apill that's available or a
couple of different brands, it'sreally going to be
revolutionary.

SPEAKER_00 (01:01:11):
That's great to hear.
What are your feelings about thepeople who are thin, but they
want to maintain their weightand they're taking these?
I mean, it is all

SPEAKER_01 (01:01:21):
over.
I would advise against that.

SPEAKER_00 (01:01:23):
Yeah, tell us more what your thoughts

SPEAKER_01 (01:01:25):
are.
Well, I just, you know, look,I'm not an expert in this area,
but I worry about the long-termeffects.
Because some of it affects thepancreas, some of it affects the
brain, and who knows?
That's good to know.
Good advice for everyone.

SPEAKER_00 (01:01:41):
That's not a medical expert advice.
I understand.
But we don't know.
It hasn't been around longenough for us to see the side
effects that could come later.
It's really good advice rightnow because I am bombarded on
All of my social mediaplatforms, everywhere I look,

(01:02:01):
take a microdose of semaglutideand just maintain your weight.
So they're really pushing ittowards so many people.
There are so many companies outthere doing this right now.
So I'm glad to hear that fromyou.
I've heard it from anotherphysician that we don't know the
long-term effects.
So be really wise when you'retaking these GLP-1 drugs.

(01:02:27):
All right, so we all have oneperson that really believed in
us growing up or later on inlife that sticks out in our
mind.
Is there someone who...
really made an impact on you,maybe said something to you when
you were young or believed inyou that you think kind of like

(01:02:50):
started your trajectory in life?

SPEAKER_01 (01:02:53):
Yeah, yeah.
I had three great mentors.
One was a history teacher inhigh school, great guy.
One was my mentor in surgerywhen I got my first job.
And then one was the chairman ofmy board when I was at

(01:03:18):
Geisinger.
And all three were greatmentors.
They're all gone now because I'mso frigging old.

SPEAKER_00 (01:03:25):
Young at heart and young in the

SPEAKER_01 (01:03:27):
mind.
But I actually had theopportunity to write to them
before they died and thank themfor their mentorship.

SPEAKER_00 (01:03:37):
That's great.
What did your history teacher inhigh school instill in you that
resonated with you?
You

SPEAKER_01 (01:03:43):
know, when I went to college, I thought I was going
to be a history teacher.
I went to college and as youknow, I concentrated in history
and literature.
When I was an undergraduate, Ithought I was going to go to
graduate school in history.
And I think he just, you know,he just really turned me on to,

(01:04:05):
you know, to the world of themind and asking really
interesting questions.
looking at primary data and, youknow, it was early on and
unusual, you know, to be exposedto somebody who said, go to the
primary data and, you know, askquestions about it at the high
school level.
And his name was Kari, PaulKari, great guy.

(01:04:27):
And we had adult conversations,you know, before I was an adult,
you know, which was kind ofamazing.
Subliminally, that was a bigdeal.
It was a big deal.
I

SPEAKER_00 (01:04:39):
think that is so true.
I have heard from so many peoplethat something in their younger
life really stands out to themand we all remember it to this
day so I love to hear that we'realmost done here but is there
anything else you would like toshare just about a purpose
driven life because you reallyhave achieved that

SPEAKER_01 (01:05:01):
yeah well again I think the theme is to really
enjoy yourself as you move alongbecause you never know what
tomorrow is going to bring.
Number two, depending upon yourown personality traits, I mean,
set goals that are notachievable, but really create a

(01:05:25):
huge amount of forward motion.
And number three is always thinkabout your next challenge.
Don't look back like we havebeen for the last hour.

SPEAKER_00 (01:05:40):
Right, you guys.
We're just going to delete thisepisode.
This was worthless.
We want to look forward to thefuture.
But I do agree with you.
I saw something today.
It said there's a reason yourwindshield is bigger than your
rearview mirror.
We need to look forward withbigger eyes than focusing on the
past.

(01:06:00):
So that's a great message foreveryone.
And yeah, thank you so much forspending the time with me today.
It's really meaningful.
And I think people will get alot out of this conversation.

SPEAKER_01 (01:06:11):
Well, it's my pleasure, Nicole.

SPEAKER_00 (01:06:13):
Thank you.

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The Burden

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From Patient Care to System Change: Glenn D. Steele Jr., M.D., Ph.D. on the Future of Healthcare

Stuff You Should Know