Ever wondered how leaders in healthcare balance innovation with the everyday challenges of running a major health system? John Couris, President and CEO of the Florida Health Sciences Center unveils his approach to expanding Tampa General's reach while launching a venture capital fund and developing a medical district.
Join us on a journey through the intricacies of creating a supportive organizational culture where failure is not only accepted but encouraged as a stepping stone to growth. Inspired by personal tales and industry challenges, we discuss the importance of authenticity, kindness, transparency, and vulnerability as the cornerstones of a thriving workplace. Feel the energy as we uncover how this approach nurtures trust, enabling individuals to innovate fearlessly and organizations to maintain their cultural integrity through commitment and training.
We confront the healthcare industry's pressing dilemmas, from care coordination to the quest for a sustainable and affordable system. Dive into the complexities of the U.S. healthcare system, dissecting the impact of policies like the Affordable Care Act and envisioning a future where collaboration drives meaningful change. Highlights include innovative ideas like food pharmacies and the potential for government-facilitated industry innovation. This episode promises not just an engaging conversation but tangible insights into the legacy and leadership required to shape a healthier tomorrow.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
Welcome to the Reverse Mullet Healthcare
Podcast from BP2 Health.
Today we are in the studiotalking with John Kouros,
president and CEO of the FloridaHealth Sciences Center, about
world-class outcomes.
Won't bankrupt the individualFirst.
Who are we, why are we here and, more importantly, why did we
name our podcast the ReverseMullet Healthcare Podcast?
Speaker 2 (00:26):
Well, we want to be relevant, informative and
creative, but we also want to beentertaining and have fun.
So it's like a party in thefront and business in the back,
like a mullet, only reversed.
Speaker 3 (00:37):
We are your hosts and I do not have the wig on, so
you can't see it in real life,Ellen.
Speaker 1 (00:43):
Brown, justin Politi and Dave Pavlik.
We are passionate, innovative,collaborative and are committed
to solving some of ourindustry's most pressing
problems along with our clients.
We have a combined 90 years ofexperience.
Speaker 2 (00:56):
A bunch of old fogies we are.
Speaker 3 (00:58):
Speak for yourself, although I am actually older
than you.
So anyway, marginally, yeah,although.
Speaker 1 (01:03):
I am actually older than you.
So, anyway, marginally, yeah,anyway, and each episode we're
going to dig into a hot healthcare topic and potentially dig
into each other.
Just don't dig into me.
Speaker 3 (01:11):
Be gentle please.
Speaker 1 (01:12):
Yeah.
Speaker 2 (01:12):
Yeah, not chance.
We'll see about that, all right.
Speaker 3 (01:14):
Never, I can try at least Okay.
So I'm really excited to haveJohn back with us for a full,
full episode this time Back inJanuary, because I have to tell
stories right Back in January atJP Morgan.
Speaker 1 (01:28):
We do only have about an hour.
Yeah, it's not that long of astory.
Speaker 2 (01:32):
We'll do the Ellen abbreviated version, which means
it's six hours long, yeah asJustin said, it takes Ellen a
while to land the planesometimes.
So I'm going to land the planequick on this one.
Speaker 3 (01:41):
So I was at a Centerview Partners event with
some very, very impressiveleaders in our industry.
It was a variable who's who ofC-suite and I was asking
different folks.
I said who do you think are theunicorns in healthcare?
Who are the people inhealthcare that are actually
affecting real change?
(02:02):
With all caps right, becausethat's our thing and your name
came up three times in that roomto me like and this isn't like
conversation, you know goingaround the room and I was like,
well, now I have to meet thisJohn chorus Like, and the irony
is stalker.
Speaker 1 (02:15):
Yeah, yeah, yeah.
So the irony is you know.
Speaker 3 (02:18):
I'm in San Francisco for this event.
I happen to live in Florida andColorado.
My daughter goes to school inTampa and I'm thinking how have
I, how have I missed this?
Right, I've got it so.
So then we went back to Viveand we were recording episodes
and I, on the way in the plane,tagged you and said I want to
(02:39):
talk to some unicorns and JohnCorris, you're on my list.
And we talked and you came onthe podcast and and I I just I
really enjoyed hearinginnovation that you're working
on, um, and yeah, it was justkind of the story.
And you were like, yeah, I'llcome back and talk to you guys.
So here we are.
So I'm super pumped.
Speaker 1 (02:57):
I will also say that on the way here on the ride over
today, I'd listened to thatpodcast and I remembered that
when John walked in the room,first thing he said we had never
met him.
She just, by some stroke ofluck, he was going to be
available and was able to gethim to come down to the studio.
He walked in and he said y'allready to have the time of your
lives?
We said, uh-oh, why?
Speaker 2 (03:22):
yes, we are.
Speaker 1 (03:23):
Yeah, yeah, yeah.
Speaker 2 (03:23):
Well, I hope you can top it today.
I'll try.
All right, fangirl, that'senough, so let's take a few
minutes to actually introduceJohn.
He is the president and CEO ofFlorida Health Sciences Center,
which includes Tampa General, inpartnership with the University
of South Florida.
Under Coruscant's leadership,tampa General's footprint has
grown from 17 facilities to morethan 150 care locations
(03:46):
statewide, including sixhospitals.
He helped launch a venturecapital fund, tgh Ventures.
He is executing Tampa General'slargest master facility plan, a
$550 million capital commitment, by creating a growing medical
and research district indowntown Tampa.
He was recently appointed to athree-year term as a member of
the Florida Health CareInnovation Council.
(04:09):
Before joining Florida HealthSciences Center, he served as
president and CEO of JupiterMedical Center in Jupiter,
florida.
He also served in variousexecutive leadership roles at
BayCare Health and began hiscareer at MassMGH.
Roles at Baycare Health andbegan his career at MassMGH.
So Coris is a graduate of BUand holds a Master of Science in
(04:30):
Management from LesleyUniversity in Cambridge,
massachusetts.
He holds a doctorate inbusiness administration
management sciences from theUniversity of South Florida
College of Business, where he'sa research fellow.
His dissertation examined theimpact of the practice of
authentic leadership on teamsand organizations.
He's a proud husband and fatherof two children, and his
professional accolades read likea compendium of who's who in
(04:53):
leadership, healthcare,innovation and thought
leadership Another classicunderachiever.
Speaker 3 (04:57):
Yes, and just for the record, I had to cut the
accolades because it literally,I think, would have taken the
entire episode to read them all.
Speaker 4 (05:04):
That's my staff who I still list it all out.
Speaker 2 (05:07):
So you were in Boston for a long time.
Yes, all right Did you everwatch?
Speaker 4 (05:17):
see Little Joe Cook at the Cantab.
No, who's Little Joe Cook?
Speaker 2 (05:19):
He was an institution Cantab was a Cambridge mass bar
and Little Joe Cook was a bluessinger and he was there for
years.
Speaker 4 (05:27):
So a bit of an institution, yeah that's
Cambridge, though that's thePeople's Republic of Cambridge.
It's very different from thecity of Boston.
Speaker 2 (05:38):
It is that area of Leslie, right near Harvard
Square, walking distance.
Did you say Harvard Square?
So that's the other one.
You like apples, don't you?
I do?
I got her number.
How about them apples?
Speaker 3 (05:53):
What he just pulls them out Good Will Hunting.
Yes, yes.
Speaker 4 (05:59):
Oh, wow, wow.
Just saying I'm going to bringyou with me on trivia next.
Speaker 3 (06:05):
You would win with this one.
Speaker 1 (06:07):
You talk about some obscure references.
Speaker 3 (06:09):
Keep going, you got any more so.
Speaker 2 (06:13):
We could probably talk all day, you guys are in
Boston, yeah.
I lived in Alston, then movedto Watertown Square, waltham,
and then subsequently movedfurther, crossed the border
eventually into New Hampshire notax land.
I'm from Swampscott.
Speaker 4 (06:32):
Massachusetts, just to the north of the city by
about 15 miles.
You still have family there.
My whole family is still in NewEngland.
Okay, most of it.
Speaker 2 (06:40):
Most of it.
So we're in Salem, NewHampshire now.
Speaker 4 (06:43):
Yeah, I know it.
I went to school high're inSalem, new Hampshire.
Speaker 2 (06:44):
Now but yeah, I know it, it's a school, high school
in New Hampton.
Speaker 4 (06:47):
Yeah, In New Hampton, new Hampshire, right off.
Speaker 2 (06:49):
Lake.
Speaker 4 (06:50):
Winnipesaukee.
Speaker 2 (06:51):
Yep.
I used to live in LakeWinnipesaukee, apogos Bay, south
Down Shores.
Speaker 4 (06:56):
Meredith New Hampshire.
Speaker 1 (06:59):
Is Good Will Hunting the Beautiful Mind, a beautiful
mind movie no that's different.
Speaker 3 (07:03):
No, but there is a good, beautiful mind aspect.
Speaker 2 (07:05):
with that solving equation, there is a beautiful
mind aspect.
Speaker 4 (07:09):
But wrong movie, wrong state.
Speaker 3 (07:11):
He just likes to bring it up so they can make fun
of me, because they make fun ofme trying to make a connection
and I screwed it up.
Speaker 1 (07:16):
I will edit that out, potentially.
Speaker 3 (07:18):
All right, last bit of the fun You've hiked Machu
Picchu.
Speaker 4 (07:23):
I did.
I did back in gosh when I wasin high school.
Speaker 3 (07:28):
And not a repeat item for you.
Speaker 4 (07:32):
No, not a repeat item .
Check that off the list.
It was kind of cool, it was alot of fun.
I'm glad I did it.
We went up to Wainu Picchu too.
So if you've ever been to MachuPicchu, there's the Inca city
and whatever the town.
But there's another peak and ontop of it is a temple dedicated
(07:58):
to the moon and the sun and youcan climb up that.
It's not a long hike but it's avery steep hike.
That's kind of a neat thing todo.
It's not a long hike but it's avery steep hike.
That's kind of a neat thing todo but it's a one and done.
Speaker 3 (08:08):
But that kind of probably was the nail in the
coffin on that one like theextra steep.
Speaker 4 (08:13):
It was the one and done for me.
Speaker 3 (08:16):
But so, in good news, though, the last time we talked
you were headed to London andCroatia.
Yeah, it was awesome.
Speaker 4 (08:20):
Was it?
Did it top Rome?
Yeah, it was awesome.
Speaker 3 (08:21):
Was it?
Did it top Rome?
Speaker 4 (08:24):
Very different.
So I would highly recommend wewent to Croatia, to Dubrovnik,
we went to Montenegro and wewent to London.
I would highly recommendCroatia and Montenegro, and
London is one of my favoritecities in the world.
It's wonderful, but Croatia isa definite.
If you haven't been, you got togo.
Speaker 3 (08:47):
It's high on my list.
So I was.
I was very.
I was like, oh, we're going tosee John and I get asked him
about Croatia.
Speaker 4 (08:50):
It's like a less expensive version of Italy.
Speaker 1 (08:54):
So you said you loved Rome.
How does, how do you comparethe two?
I think they're very different.
Speaker 4 (08:59):
Italy is such a special country and Rome is just
this incredible city, as youknow, um totally different,
totally different, you know.
I mean like croatia was formeryucoslavia, right?
So it's you, you know, croatia,um montenegro, they're still
developing.
(09:19):
Yeah, you know, in a crazy way,even though it's it's been a
while since the 90s, they'restill developing.
So it's very, very different.
I mean, in Rome, you feel likeyou're stepping back in time,
right?
You really feel like you're.
Well, you are right, right, youwalk in that.
Speaker 3 (09:34):
Colosseum and you're like wow.
Speaker 4 (09:36):
Wow, this is like the real deal, yeah, yeah very
different Okay.
Speaker 3 (09:45):
Well, I'm going to have to.
You're going to reel us in.
I'm going to be the guy You'removing from the party in the
front, all right.
Speaker 1 (09:47):
Yeah, I'm going to slide us into the business in
the back part, but I'll do it ina fun way.
We took failures.
We're going to talk aboutfailures again.
You made headlines when yousaid we don't do pilots and
celebrate failure.
When you were speaking at themain stage on vibe, where five
where we, where we met you andthen we, we first met we started
(10:11):
to scheming, we started shouldI say scheming?
Is that the right word?
Speaker 3 (10:14):
I don't know, it has a negative implication, but I'm
going to stick with it.
Speaker 1 (10:18):
We were more.
We were more spitballing theidea of a failures of a failures
conference.
Speaker 3 (10:24):
Yes, yes, so tell us your thought on that.
Speaker 4 (10:29):
Well, I'll tell you what after Monday, when I test
drive the concept with yes, withEllen.
I will be there with you.
We'll test driving together.
But Ellen and I are going totest drive it together and it's
going to be kind of neat becausewe're going to do it on a
podcast, we're going to do itwith podcast, we're going to do
(10:50):
it with, I think, 100, 150, 200people in the room and we're
going to go decade by decadeabout, um, my failures and
mistakes.
So it's sort of a combination.
So it's a mix between a projector two that has completely
failed and why, and then whatdid you learn from it, or what
did I learn from it.
But then there's also theleadership.
You know mistakes along the way.
So I'm excited about doing itand if it goes well which I know
(11:13):
it will, because Ellen isemceeing I think we should turn
it into a conference.
Speaker 3 (11:20):
I agree.
Speaker 4 (11:22):
Everybody I talk to about a failure conference.
Even if it's for like two days,people love it.
Yeah, everybody loves theconcept.
Yeah, I mean going to a normalconference and hearing about all
the good work that's being donearound the industry is
wonderful and it's important andit's seeing those conferences
are significant.
(11:42):
But literally going to aconference and only hearing
about failures and mistakes Ithink that's where the deepest
and richest learning comes from.
Great, so I hope Monday will gowell and it's well received.
Speaker 3 (12:01):
And if it is, then we need to make it happen.
We're in, yeah.
Speaker 1 (12:03):
It's going to be great.
You've got to find leaders thatare willing to check their ego
right the door.
Come in and be humble right.
Speaker 2 (12:13):
That's why it's rare to find a leader that celebrates
failure.
Speaker 4 (12:16):
Well, when I went through all my failures and was
preparing earlier this week fornext week, I cried myself to
sleep.
After the one session I hadwith my chief of staff and my
vice president of corporatecommunications, jennifer
Crabtree who's wonderful, welove Jennifer I was like I'm
laying in bed.
(12:36):
I'm like I should be weepingright now.
You know, but I'm reallyactually looking forward to
sharing it, cause I think when,um when people don't think they
make mistakes or are unwillingto share mistakes, I think
that's a huge missed opportunity.
I do, and I think there's a tonto be learned, so I'm excited
(12:59):
to share them.
Speaker 3 (13:00):
I'm excited.
I think the other thing too isI've had such an immense respect
for your philosophy on failure.
Partly it's near and dear to myheart because we have an
individual who was a client ofours for a number of years.
Honestly, if I had to line upunicorns in rank order in
healthcare but on thetraditional side, there's a
(13:23):
bunch of really innovative stuffover here that point solutions,
their ideas, their disruptors,but they're not managing the
day-to-day of healthcare, theunderbelly of it.
That's a hard place to live.
It is a very difficult placeto—a lot of people like to point
fingers at institutions and sayyou're the reason.
This is a system we built.
(13:45):
We should be much moreappreciative of what's happening
there.
This particular individual wasprobably the most disruptive,
willing to take the most boldrisks, but calculated risks.
That person ended up.
They're not in the industryright now because the bet that
(14:06):
they made the partner that theychose wasn't holding up their
end of the bargain and thatreally hit like.
I had a hard time with that andI think it's important.
It's like wait a minute, thoughthat was a what?
If that risk had paid off, thatcould have been game changing
for the industry.
And now we lost that personbecause of that one thing.
So anyways.
Speaker 2 (14:27):
So how do we tolerate or find some level of balance
between accountability andadmitting mistakes?
Obviously, we want to begetting people to be encouraged
to take chances and risks, butwe have this in our society that
if I do that then I have a riskof getting fired, and so I'll
kind of stay in my lane and notdo that.
(14:48):
What are your thoughts on that?
Speaker 4 (14:49):
Well, I think it starts with like creating a
culture that sort of encouragespeople to take chances and to
make mistakes and to celebratefailure and to do the things you
need to do.
So in my world it's reallysimple.
(15:11):
We've got four key attributesto sort of the world we live in.
We lead and treat each otherwith authenticity, so we are our
authentic selves.
We don't try to be somethingthat we think the organization
or other people want us to be.
We sort of embrace who we are,even with all our idiosyncrasies
(15:34):
, right.
So authenticity createsrelatability.
Relatability creates trustright.
In a lot of cases, we also leadand treat each other with
kindness right.
In a lot of cases, we also leadand treat each other with
kindness right.
So we spend a lot of timetalking and understanding what
kindness is, what empathy is,what love is, and we lead that
(15:55):
way, we treat each other thatway.
As you lead people and treatpeople and build an environment
where people are treated withkindness and love and empathy,
you create psychological safetyin a really significant way.
The third aspect of our work andhow we do it, to answer your
(16:17):
question, is we lead and treateach other transparently.
We share almost everything.
The only reason I say almost isbecause, of course, if there
are things that need to beconfidential, if it's an
employee issue or a team memberissue, excuse me.
So if it's a team member issue,if it's a patient issue, if
it's a delicate strategic issue,of course we're going to keep
(16:40):
those confidential.
But most everything we do welay it out there for team
members.
We hold very little back.
And then finally and that buildstrust that builds big time
trust, because no one likes tooperate in the opaque.
I mean, if you've ever workedwith somebody or collaborated
with somebody or worked forsomebody who isn't transparent,
(17:02):
it's very distracting andlimiting.
And then finally, we lead withvulnerability.
We show real vulnerability likeI don't know something or I
made a mistake right or I askedfor help.
That's vulnerability.
When you start to do thesethings on a consistent, everyday
basis and it becomes part ofthe DNA of the organization,
(17:26):
you're able to sit in front ofhundreds of people and talk
about your failures.
You're able to talk about yourmistakes.
Why?
Because you know that theorganization isn't going to
judge you, that the organizationwill embrace it, celebrate it,
learn from it, move on from it,grow from it.
So that's how we do it.
(17:48):
It's not supernatural, it justis very intentional, deliberate
work.
Speaker 1 (17:53):
It's a culture you built.
Speaker 4 (17:54):
Yeah, it's a culture we built and, believe me, we
work on it every single day.
Speaker 3 (18:00):
You have an acronym for it and you wrote a case
study on it.
Right, we did.
Speaker 4 (18:03):
It's called ACTIV Good, great memory.
Look at you with your notes.
I didn't even look at my notes.
I remembered it.
Speaker 3 (18:09):
You were talking about it and I was like he's
describing ACTIV.
Speaker 1 (18:13):
And I was going to ask him about that later, what
does it stand for?
Speaker 3 (18:17):
He just gave you all the words.
Speaker 4 (18:25):
It stands for leading with authenticity, kindness,
transparency and vulnerability,and you put those words together
and it's active.
It's something we train on.
So every leader and every teammember in the organization is
trained on this.
We are constantly talking aboutit and using it and socializing
it.
We hold each other accountablefor it and in a rare occasion
when a leader struggles with itand gets to a point where you
(18:49):
have to make a determination arethey unwilling to adhere to
active or are they incapable ofadhering to active, or is it a
combination of both?
They got to leave.
I mean, we're, we're, we'rereally very committed to it.
Speaker 3 (19:05):
It's impressive and you did so.
I'll just stick with this, Iwon't.
You know, the whole point ofthis is to be able to have a
conversation is so, but you'reso passionate about it, not only
do you lead that through yourorganization, but but you
actually wrote.
You wrote a peer reviewed likethere is.
There is a peer reviewed studyon the efficacy of this approach
(19:27):
right that you published thisyear.
Speaker 4 (19:30):
Well, actually true.
So the active model came frommy dissertation and my doctorate
program.
Yeah, so it's a verywell-studied, very
well-researched and there's lotsof data that shows that what
I'm sharing with the audienceactually works.
And when people say well, whatdoes that mean?
It works Well, it has improvedteam member engagement in our
(19:51):
organization significantly.
I mean we operate with teammember engagement well above the
national averages and um inteam member engagement.
I mean well above it.
Like always, we're always inthe top quartile or decile in
engagement.
It has created an environment ofpsychological safety.
You cannot innovate and createif you don't feel safe in the
(20:14):
environment.
You're doing that, you can't,or you can't do it as well as if
you were in an environment thatfostered all of that.
And then, finally, it buildstrust.
And then when you can have anorganization that feels safe,
feels protected, and you have anorganization that's completely
(20:34):
engaged and you have a team ofpeople that trust each other,
your performance is you becomeunstoppable.
See what's interesting aboutour industry.
I say this to my chiefadministrative officer, who has
the strategy group reporting.
To her I said you know everyhealth system, or most health
(20:57):
systems.
Maybe there's super enlightenedhealth systems and in in the in
in our industry.
But most health systems um, wethink our strategies are novel
and they're different and unique.
They're not.
They're all variations of atheme.
You travel the country, youtalk to all of us in the
industry and we talk about thesame things.
(21:19):
We're going to build hospitals.
We're going to build out anambulatory network.
We have to do more inpost-acute.
We have to do better with ourteam members.
We have to recruit morephysicians.
We have to do more inpost-acute.
We have to do better with ourteam members.
We have to recruit morephysicians.
We've got to build more stuff.
We've got to expand ourfootprint.
Now the configurations aredifferent and there's slight
variations to the general theme,but it's basically the same
(21:40):
strategy across the country.
What is very different fromsystem to system?
People, culture and anorganization's ability to
execute a plan.
Speaker 3 (21:53):
Absolutely Very different Very.
Speaker 4 (21:56):
Our secret sauce in TGH and USF is not the actual
strategy, it's our people.
I'm unbiased, but I'm also arealist.
We have some of the best peoplein the industry.
I'll put my team up against anyteam in the country and we will
out-execute any team in theUnited.
Speaker 3 (22:17):
States.
So I'll give a, because I haveinsider information right now
that nobody else knows?
In preparation of Monday is andsee we have trust.
I can see we have built trustbecause you didn't look at me
across the table like, oh, goodLord, what is she going to say?
Was I thought the learning thatyou had from your decade at
(22:40):
Jupiter Medical.
I feel like that really feedsinto your ultimate commitment to
how you lead now.
Speaker 4 (22:46):
A hundred percent.
Speaker 3 (22:47):
Right.
I thought that was reallytelling was I was the one that
controlled it.
I held onto it tightly and then, when I left, it all fell apart
, and so I love sitting hereknowing that that was, in your
mind, a failure, that now, inthis next decade, you've done
completely differently.
I just needed to practice forMonday.
Speaker 2 (23:07):
Maybe you could give Bill Belichick some advice.
Speaker 4 (23:10):
Yeah, right, right, right.
No, I did.
I mean the Jupiter experience,just to foreshadow a little bit
of what Monday is going to be.
I mean, the Jupiter experiencewas a mistake.
I wouldn't characterize it asan out-and-out failure, because
the institution did extremelywell and and.
But when I left, when I I waswatching all sorts of things
(23:33):
online, and when one of my boardmembers you know because they
were coming to me and saying,well, we need help with this,
what do you think about this,what should we do here?
And you know I love the place,so I was totally available and
willing to help and guide andprovide whatever information I
could.
But I was shocked at howquickly some things not all
(23:56):
things, but some things justunraveled.
And I actually said to one ofan old board member of mine I
said, well, what, what's goingon?
He said, well, john, and thiswill be like the cliffhanger he
said, john, you're the leader.
We were all on a path that youhelped create.
(24:19):
You're leading us down the path.
And when you left the path, weall stopped walking the path and
said, well, what do we?
What do we do now?
Yeah, like what?
Okay, so what?
What do we do right now like wehave a plan, but john was our
leader driving the plan we werefollowing john leader and john.
(24:40):
Right, we're following john.
Maybe not the plan, maybe wedidn't understand the plan, but
we trusted John and I didn'tthink like I thought I was
educating them on the plan.
I probably wasn't educatingthem to the extent that I should
have or could have.
(25:01):
It wasn't done intentionally.
I thought I was doing it, but Iwasn't doing it obviously
enough or the right way in thatparticular case.
And so when I left, stuff thatwas just grounded in great
analytics and just good planschanged and it hurt the
(25:21):
organization, hurt theorganization and my.
The coaching I got from one ofmy board members was well, it's
not anything like.
His comment was oh, you didanything wrong.
You just made a mistake, youdidn't you?
You thought these folks werecoming along more than they were
and they weren't Yep, yep.
Speaker 1 (25:42):
This has given me a new appreciation for well, I
should say, my.
My wife is a human resourcesleader at a large health system
in northern Virginia and thething that she's always the most
proud of is when they get thoseengagement scores.
And you know, I don't know ifthey have something like active,
but certainly the pillars, thepeople pillars.
Speaker 3 (26:01):
I bet Sarah is going to learn about active whenever
you see her again.
Speaker 1 (26:04):
I might tell her yeah , you know why not Share the
wealth?
Speaker 4 (26:08):
Yeah, but it's given me a new appreciation for what
she gets so excited about allthe time.
Speaker 3 (26:19):
It's all about the people man, absolutely Well, so
okay, so I am going to take usto the question.
Really, the platform purpose,the passion purpose of this
whole podcast, is to bringthought leaders like you, john,
to your point.
Variations in theme.
But I think what we don't havea chance to do, I think we spend
so much time in our lanes andin transactional conversation
(26:40):
and in operational details thatwe lose the opportunity to have
true non-transactionalconversation about how to affect
real change in all caps.
And you were cited.
I really liked you saying whenwe were prepping for this
episode, you said because youknow I have this passion for I
(27:03):
want to see us reverse lifestyledisease and I'm not talking
about prevention and wellness,you and I have clarified that.
But I really liked your pointof like hey, I'm doubling down
on care coordination, my job isto help you when you are sick
and I think that's a really goodline to do.
And and so you were quoted in ahealthcare business day article
(27:24):
recently.
You were interviewed in part ofa thing and you said we need to
do a better job as an industryon care coordination, patient
experience, access andconvenience.
And you went on to say we arecreating a healthcare ecosystem
that provides a frictionlessenvironment for our patients,
physicians and allied healthprofessionals.
Tell us your vision and ifthat's not your vision of real
(27:45):
change, you can change the topic.
But you know, as we push thingsalong and it can be incremental
, but you know what's that kindof push to make a difference
when people complain abouthealth care or whatever.
Speaker 4 (27:59):
Well, it's a great question.
I mean, we're on anunsustainable trajectory in
health care?
Speaker 3 (28:04):
Yeah, absolutely.
I mean.
We're on an unsustainabletrajectory.
Speaker 4 (28:06):
Yeah, absolutely.
I mean, you know, 17 to 21% ofthe GDP is spent on healthcare,
depending on the year, and itdoesn't really go lower.
It's kind of stuck there andinches up.
You look at quality, you lookat clinical outcomes.
You look at the most recentCommonwealth report, which is a
wonderful report to look atbecause it's not a partisan
(28:30):
report, it's sort of like just areport on health care and you
look at our quality compared tothe other 10 or 11 largest
industrialized nations in theworld.
There's lots of reasons forthis.
We're like dead last at almostevery quality indicator.
(28:51):
Now, don't get me wrong.
There's wonderful work beingdone around the country by
really incredible and specialhealth systems, but we're not
moving the needle.
Health and wellness isn't goingto do it, not in our lifetimes,
not in our lifetimes and maybenever.
I think health and wellness isa component of care coordination
, but I don't think it's thebusiness that we're in.
Speaker 3 (29:12):
At least the sector of the business that I'm in.
That point to me is what Ialways kind of go back to is and
I experienced it with my momshe actually had almost died a
year and a half ago at JupiterMedical Center.
So thank you for the work thatyou had done, because it is a
really good facility.
You've taken very good care ofher twice.
(29:33):
But I walked out of thererealizing you go to the hospital
to be kept alive, you areacutely ill, you are
experiencing an acute incidenceof sickness.
There's something really wrong,right, and you're going to the
hospital to be kept alive and tonot be sick.
The job of the hospital is notto make you healthy, and I think
(29:56):
that's where we go kind ofwrong as a system is.
We really have not builtanything for that To teach
people and help people how to behealthy.
We expect them to just figureit out.
You know and I don't want to, Idon't want to answer that right
now, but my point is I agreewith you that that we have built
a system for what it's intendedto do, which is you're really
sick, we're going to help you,right, and that's what that's
(30:18):
your job Like.
That's that's what you're askedto do and you're tasked to do.
Speaker 4 (30:29):
That's right, and we struggle with it across the
country.
Yeah, so why would we get intoother aspects of the business if
we can't figure out the corecompetency of the business, if
we can't figure out the mainreason why we exist?
All this diversification?
And I'm going to be a healthand wellness platform, I'm going
to be an insurance company.
I'm going to be verticallyintegrated.
Well, wait, I'm going to be aninsurance company.
I'm going to be verticallyintegrated.
Well, wait a minute, we don't dothe core work well enough.
(30:50):
As an industry, we don't dothat work well enough.
So when people say, well, whatis that work, john?
It's care coordination.
It's coordinating care, it'seliminating friction, it's
eliminating silos, it'seliminating that fragmentation
that exists in the system andthat drives quality down and
(31:12):
increases cost.
In any other industry wherethere's friction, where it's
disjointed and clumsy, it addscost and it doesn't create value
for the consumer.
So what do other industries do?
They fix it.
We struggle with that.
We do.
And it's not an indictment onthe industry, because I'm a
(31:35):
product of the industry.
I have nothing but a ton ofadmiration for my colleagues
that are trying to figure it out, just like I am.
Just don't think as a totalindustry.
We've embraced the concept ofcare coordination.
Speaker 1 (31:49):
But most organizations will tell you we
do care coordination, we dopopulation health.
Speaker 4 (31:54):
So what I mean about care coordination.
I wrote about this.
It was actually published in amodern health care magazine in
like a two-part series.
We published it in a two-partseries.
The title was sort of Untyingthe Gordian Knot of Healthcare.
Care coordination is kind ofthe way.
And the reason I wrote the paperwasn't because I thought I had
(32:16):
great, you know, knowledge tobestow on the industry.
It's just that when we startedto socialize care coordination
at my health system, everybodyhad a little different idea of
it and they were running offdoing all sorts of different
things and I wanted to bringeverybody back and focus them.
So I basically wrote, with ateam of people, a manifesto that
(32:40):
said this is care coordination,this is our rallying cry, this
is our true north.
So care coordination to me it'snot population.
Health Care coordination to meis a fundamental shift in the
healthcare systems operatingsystem.
So it's like building an iOSsystem for healthcare, like
(33:05):
Apple has on their phone andwhat I tell people all the time
because Apple most of us canidentify with it.
I said what makes Apple great,it's its operating system, it's
not the phone, it's not thetablet, it's not the computer,
don't get me wrong the phone,the tablet, the computer, the
earphones they're pretty cool,they're well-designed, they're
well-constructed.
They're earphones they'repretty cool, they're well
(33:26):
designed, they're wellconstructed, they're fun,
they're hip.
They're all the thingseverybody wants, but the
stickiness.
The reason why people loveapple apple will tell you this
is their ios system.
It is a closed loop system thatboth designers and developers
(33:46):
and users and consumers coexistand when you're in the ecosystem
it's reliable, it's safe, it'sintuitive, it's friction, light
or frictionless.
It's not siloed and fragmented.
It applies sort of a systemsthinking to how they deploy it
(34:08):
and how people either create init or are users in it.
Why can't we create anoperating system like that for
healthcare?
That's care coordination to usat TGH and at USF, no, it sounds
very.
Speaker 2 (34:23):
It's exactly what we've talked about in so many
different instances of like.
You're the type of entity thatif I was a payer, I'm saying.
A lot of payers have their ownlike idea of what care
coordination should or shouldn'tbe, and there's a lot of
overlap.
But why can't I just delegateit to you?
If you are doing all of thisand do it on behalf of all of my
members, right, we pay you forcare coordination.
(34:44):
If we all align to say this isthe right direction.
That's pie in the sky, I get it, but there's a lot of overlap
in care coordination going on,because we're all confused in
the industry right now.
Speaker 4 (34:55):
Providers think they're payers and payers think
they're providers, and then theygo.
And don't get me wrong.
I mean there's great businessmodels.
I mean, look at United Optum,they print money.
You just look at UnitedOptim,they print money.
Okay, you just look at theirstock, look at what they're
(35:16):
doing, look at the money they'veaccumulated.
They do a great job.
Now I don't think they shouldbe in the provider piece.
They're in the provider spacebecause they want to retain
first dollar coverage as much asthey can in their own system.
They're not trying to save theworld, they're trying to build
and they've built a businessmodel that is very lucrative.
That's why they're doing it.
So why not pay or be a payerand get into health and wellness
(35:42):
, get into the front end of thatjourney for your beneficiaries,
but then help and partner withus as providers.
Get into health and wellness,get into the front end of that
journey for your beneficiaries,but then help and partner with
us as providers.
That doesn't happen in thisindustry.
Speaker 3 (35:53):
No, it's very overlapping.
I think it gets back to theeconomics.
The economics are verymisaligned and very disjointed
and sort of removed.
You don't have a choice.
Our health care dollars areinvested on our behalf.
I mean, I happen to have my owninsurance so I can pick, but
it's not like there's some grandplan.
(36:14):
There's a limited choice ofoptions of what's going to be
covered for me.
So our healthcare dollars areinvested for us and they're
invested into a system that's tokeep me from dying, into a
system that's to keep me fromdying.
It's not.
It's not meant to keep methriving, it's not.
That's not the system we built.
And so I think you know we, weneed to start, we need to step
up to the plate and own that.
(36:35):
That like if I want aworld-class institution to go to
, if I am on death's door or Ihave something really wrong with
me, then I want to go to TGHand know I'm going to get taken
care of and then I'm going toget the best care and it's going
to be coordinated.
I'm going to be.
You know what I'm saying.
Then you're going to dischargeme and say, okay, now if you
(36:56):
want to get healthy again,that's go do it, you know what I
mean.
Speaker 4 (36:59):
Like that's not your role or partner with people that
can do it, I mean look, we havea really, really great
relationship with Florida BlueGuidewell.
Speaker 3 (37:09):
Shout out to Lee Bowers Medicare.
Speaker 4 (37:11):
We love Lee, that's right Pat Garrity, who's the CEO
and the president of the wholething Excellent, great visionary
, great guy.
His team's wonderful.
We don't always agree.
There's plenty of times we fussat each other, but we're great
partners because we both kind ofbelieve in the same thing but
look at it a bit differently.
Speaker 3 (37:33):
You own your spaces.
Speaker 4 (37:34):
We own our spaces.
He does have clinics and doesprovide care, but he does it in
certain markets where it'sextremely expensive and he feels
like he needs to do somethingdifferent.
That's his prerogative, I think.
Personally, I think it takesmore time and it's more work,
but I'd spend more timepartnering with health systems
(37:57):
and I'd spend more timepartnering with folks.
But he's a great partner andhe's a wonderful guy.
We have a wonderfulrelationship with Lone Blue.
We collaborate on all sorts ofthings.
They teach us the payer world.
We teach them a little bit ofthe provider world.
We sit down and we try toinnovate together.
A great example is Pat and histeam, florida Blue.
(38:19):
They were the first commercialpayer that we had that actually
paid us for hospital at home.
We had commercial payer that wehad that actually paid us for
hospital at home.
It actually started acommercial plan with us that
provided us a commercial plan.
I mean that's great.
Those little innovations really, really matter.
But again, there are a few.
(38:41):
There's very few of thosepeople out there.
I'm telling you this is just myperspective.
It's a little weird.
Like I said, you've got payerswanting to be providers and
providers wanting to be payers,instead of sitting down and
saying there's got to be abetter way.
Speaker 3 (38:57):
Right, I'm delivering .
But see, I'll just add that Ithink ambulatory care is where
it gets a little muddy andeverybody's kind of chasing,
because to me that's the area,that that's a connector, right
Cause it's like, okay, I cameout of the acute care setting,
I'm not ready to just be at home, I've got to enter this sort of
ambulatory space, right, or I'msick, but I'm not acutely sick,
(39:21):
right, and.
And then the problem is that ifthe health system is just
focused on the acute, but theywant to be able to feed by using
ambulatory their focus is onthe acute then they're not going
to do ambulatory well, so thenthe health plan says wait, I
need ambulatory.
You know what I mean.
So then it gets this like muddyground and the sad part is that
that's actually where there's alot of money to be made and
(39:44):
whoever's going to own thatperson in terms of trying to
minimize their touching into thehospital system you know what I
mean.
Hitting that acute care point,somebody needs to help navigate
that, and that's where I thinkpeople overlap.
It's like people are bumpinginto each other and it comes
back to who's financiallyaccountable, which is what I was
saying about the economicsbeing yeah and part of it is
(40:05):
both sides.
Speaker 2 (40:06):
Well, on the payer side basically thinks that you
know, wait, the health system'snot necessarily focused on
making sure that they're mostcost efficient as possible.
So we are going to start todeploy resources on our own to
do something to help mitigatethat right.
And then all of a sudden, youhave all these barriers put up
that the care access that docreate that friction right.
(40:28):
So you know, priorauthorizations, all those
components that just are hurdlesto actually implementing a good
model.
Speaker 4 (40:36):
Yeah, you know the federal government needs to
create an environment where theybring us all together to really
collaborate and build a newmodel.
The way we're doing it doesn'twork.
And, by the way, for thosepeople that think, well, the
solution is a one-payer system.
Let the government take it over.
That would be an absolutedisaster.
That would be a disaster, and Ihave strong feelings around it
(41:01):
because it's not political, it'sjust look, if you look at what
Obama did in Obamacare, did ithelp?
Yeah, it probably helped, butit hasn't improved quality.
It hasn't improved clinicaloutcomes or safety.
It's increased access, but allhe's done is create another pool
of underinsured people.
(41:22):
Okay, so what he's created froman economic perspective is a
bigger burden on the healthcaresystem, because when you're a
Medicaid patient, you're paid atsome version of a Medicaid rate
.
In Obamacare, you're justunderinsured.
Right, you just don't have,you're not appropriately insured
, and when you vilify the healthsystems and say, well, you're
(41:43):
too expensive.
Speaker 3 (41:44):
Well, that's, somebody has to pay for that
care.
Speaker 4 (41:46):
Yeah, but it's ridiculous because it's not the
health system's fault, right,just like it's not completely
big pharma's fault or thepayer's fault.
What our government needs to dois create an environment, hey,
where you can innovate, you cancollaborate, you can partner.
How about being incented to dothose things to build a stronger
and more resilient and morehighly reliable system for the
(42:10):
people of this country?
That's what our federalgovernment should be doing.
They should be facilitatingthis.
They should be driving ustowards this kind of creativity
and partnership.
Instead, what do we do?
Our special interest groups runaround and we vilify each other
, I agree, and nothing getschanged.
Speaker 3 (42:29):
I know, and what's interesting is, you know, when
you talk about Obamacare.
I mean, one of the things thatcame out of that was CMMI, which
is the Innovation Center forCMS, and they've launched 50
value-based programs and wecould knock them until the cows
come home and those specialinterest groups love to bash it
right.
It becomes this partisan issueof like-.
Speaker 2 (42:47):
Both sides, both sides bash.
We want it to go away and thenwait.
Speaker 3 (42:51):
This isn't saving anything, but to your point it's
actually a learning lab for newmodels, and you know what.
So what if it didn't save money, if it kept costs neutral?
We've flip and learned from itright.
And so I agree with you thatit's like we have to invest in,
in collaboration and and and arealignment, like I'm very
relieved to hear you say like itdoesn't work the way it is
(43:13):
today, cause a lot of healthsystem CEOs are like, well, I'm
doing this or I'm doing that andit's going to get better.
And it's like, no, we, we havebuilt a system upon which volume
is how you're paid and youcan't fault anybody for that.
Like, why would you want tostep up?
Speaker 2 (43:27):
and I mean you know, we're given false choices too
when it comes to this stuff.
Right, when I say that issuesare brought up and it's like
well to your point, right?
Well, we should just be singlepayer and everything like this
is going to go away.
No, that's not an accuratestatement, or we need to like
this whole concept of like.
Why aren't we working togetherand the federal government and
sending these, like everybody,to get together in a more
(43:47):
functional system, versusputting out false choices for
people and putting in their own?
Speaker 4 (43:52):
Be a convener, the federal government, convene us,
bring us together, drive us.
Instead of driving us apart,yeah, instead of driving us
apart, no.
But, ellen, it's a great point.
Listen, under PresidentKathleen Pasadena's Live Healthy
Act, she's created a 15-personinnovations committee where we
are going to take real problems.
(44:14):
I was appointed by her for thiscommittee.
We're going to take realproblems, real problems.
We're going to present them tothe industry and say innovate.
So, venture capital, privateequity entrepreneurs, health
systems OEMs, original equipmentmanufacturers, companies, come
to us with a solution to ourreal problem and let's let
(44:38):
innovation drive theimprovements in healthcare that
we have to make across the board, I might add, from the provider
side to the payer side andeverything in between I'm really
excited about this, you had meat healthy.
Yeah, well live healthy.
Speaker 3 (44:56):
I understand.
Speaker 4 (44:57):
But what, kathleen?
What the President Pasadena didis she enacted a ton of policy
over the last year to improvethe resiliency of the healthcare
system in the state.
Along with the governor andalong with the speaker of the
house and along with thoselegislative bodies, they're
created a body of policy that isactually going to if
(45:23):
implemented right and notmorphed into something and
picked apart and criticized, andall that if implemented right
and not morphed into something,and picked apart and criticized,
and all that, if implementedcorrectly, it will change the
way care is delivered across thestate and I would submit to you
that if we can do it in thethird largest state in the
country, we can do it across thecountry.
Speaker 3 (45:43):
I agree.
Yeah, I agree.
You know, I'll be sending younotes on that one.
Speaker 4 (45:47):
You can, you can.
I'll keep you updated.
Speaker 3 (45:50):
I'm just as excited about that as you are, except
I'm not on the committee.
So if you could leave a legacyon health care, in health care,
right, if you could leave alegacy, I mean I think you still
have a couple decades left.
Speaker 4 (46:04):
I have some time.
Speaker 3 (46:07):
Yeah, I mean I think you still have a couple of
decades left.
I have some time.
Yeah, I've got a long roadahead of me, but what would that
look like for you?
What would feel like the rightthing to leave?
Speaker 4 (46:14):
It's a great question actually.
You know when it's my time, letme just set the context.
So, as a leader, I believesomething, a very simple concept
, that the true testament of anyleader anywhere, any industry
anywhere, but in this case,healthcare when you're ready to
leave, retire, move to the nextgeneration gig, whatever you're
(46:38):
doing, and you can look back andyou can say you know what.
I left the place that I wasresponsible for better than when
I found it and now I'm passingthe mantle.
You've done your job as aleader, because leadership isn't
about kingdom building andcontrol as much as people do
that stupid stuff.
It's not about that.
It's not about your ego, and weall have ego invested in it,
(47:01):
and when people say, well, Idon't have my ego invested in it
.
Speaker 3 (47:04):
Oh, I know I just listened to a podcast episode
with John Mackey.
With you know, he's the founderof Whole Foods and it was
really interesting to hear hissort of self-actualized versus
ego, and I totally agree withyou.
Speaker 4 (47:25):
Right, so they're full of you know people are full
of BS when they say well,there's no ego invested in me,
and we all have a little bit ofego invested in what we do.
But that should not be how youmeasure your success, right?
It should be.
Am I leaving the place that I'mresponsible for better than
when I found it?
And when I pass that mantleonto the next generation of
leader, I'm passing a mantle tohim or her that's better,
(47:48):
stronger, more resilient.
So my legacy is I want to leavean aspect of it.
I want to leave a system and Iplan on staying where I am until
I am done, until I retire,because I'm very committed to
what we're doing at TGH and atUSF or, in a broader sense,
florida Health Sciences Center,in relationship to what we're
(48:12):
doing across the state.
I want to leave a system thatis driving world-class quality
clinical outcomes and safetyworld-class quality clinical
outcomes and safety.
That's highly reliable, meaningthat there's very little
variability in our performance,that it's sustained.
So, regardless of who you are,where you enter, you're getting
(48:33):
the same care at the same levelwith the same outcomes, and
those outcomes are world-class.
And I want to do it at a lowercost and I want to be able to
say that not only are weproducing these great levels of
quality, but we're also doing itless expensively.
Oh and, by the way, we'vepassed that value on.
Speaker 3 (48:55):
Right, not just more profitably.
Speaker 4 (48:58):
We've passed that value on to the consumer, to the
patient, to the employer, toeven the payer.
Now we have to make money.
Payers have to make money.
In my case, I'm a big private,not-for-profit academic health
system.
I can't provide care and can'tfulfill my shared purpose if I
(49:19):
have a padlock on my front doorbecause I can't run profitably.
So you've got to make money,yeah Right, but there's plenty
of money in the system.
My thesis is plenty of money inthe system.
It's how we use the money thatneeds to change.
Speaker 3 (49:36):
Listen, you know that you and I disagree a little bit
about the lifestyle diseasething.
Right, we spend trillions on it.
Trillions of that healthcaredollar that should come out is
on lifestyle disease.
We don't need to have type 2diabetics running around with
kidney failure.
Speaker 4 (49:51):
No, no, I agree with you.
Speaker 3 (49:53):
But to me that's where there's cost to take out
of the system.
There's a way to do this better, right.
Speaker 4 (50:04):
Just because you hit something, there's costs to take
out of the system and there's away to do this better, and my
hypothesis is that way is carecoordination.
Speaker 3 (50:15):
Agreed, I agree.
Speaker 4 (50:16):
Right Like creating for the consumer.
Speaker 3 (50:20):
Well, think about it, john right.
People don't know how toreverse lifestyle disease.
Speaker 4 (50:25):
Right, no, no, no, listen, we do differ a bit on
that, but I believe that healthand wellness and lifestyle
issues are a part of carecoordination.
It's just not the centerpieceof who we are.
Speaker 3 (50:37):
No, because you're an acute care health system right,
and so I actually agree withyou because I think we need a
parallel healthcare system and Ithink there's plenty of money
to go around for that.
To your point, we havetrillions that we invest in
healthcare and so if there's asystem that people can access,
(50:57):
where they can learn how toreverse their lifestyle disease
and not just treat it like, hey,I right, there's plenty of
people that want to just keepeating kfc and, and you know,
drinking soda and like that'stheir personal responsibility
with this who doesn't like thehamburger or k from mcdonald's
or kfc?
Speaker 4 (51:16):
I love it.
Speaker 3 (51:17):
We're getting ready to record a hot ones, so so so
I'll throw listen tamp, throwlisten Tampa general.
Speaker 4 (51:23):
My, my academic medical center has a McDonald's
in it.
People will say I can't believeyou have McDonald's.
My attitude is well, wait aminute, you're an adult, right?
Yeah, so you're telling me thatyou don't have enough
self-control to choose whetheryou want to go to McDonald's or
not, so I have to take it awayfrom you.
(51:44):
I don't believe in that.
If you don't want to eatMcDonald's, don't eat McDonald's
.
I know I might say thoughyou're going to love this, ellen
McDonald's has plenty ofhealthy choices on the menu.
If you don't want a Big Mac ora Whopper, you can choose
healthier options.
Speaker 3 (52:02):
Healthier Right, okay , there's a difference between
healthy and healthier.
Speaker 4 (52:06):
You can get a salad.
Speaker 3 (52:07):
That salad isn't nutritionally dense, though you
can get a salad at McDonald's,and if you're in New England
like us.
Can you get some lobster?
Speaker 4 (52:16):
You can get a lobster roll in the summertime.
Remember growing up as a kidthat was a summertime favorite
at McDonald's Real lobster in abeautiful bun, toasted,
delicious.
Speaker 1 (52:26):
I love it.
I know, I know you can get alobster roll at TGH is what I
think Justin's wondering hewants a shrimp?
Speaker 2 (52:34):
There should be some Gulf Shrimp, yeah.
Speaker 4 (52:37):
You find a lobster roll yeah.
Speaker 3 (52:40):
And you said it right , I am not one of those, that's.
The other thing is, I don'tthink idealism is going to get
us anywhere.
Right Is being an idealist inall this and trying to be a
purist.
It's not going to get us toyour point.
We have to convene, and so mything is like hey, two things.
If we're going to have aMcDonald's, then let's have a
(53:01):
bolet.
Like let's just have something.
So if I'm stuck in the hospitalI can get something healthy.
Speaker 4 (53:07):
Let's make it taste good, you know what I'm saying,
right.
Speaker 3 (53:09):
But the other it's having multiple choices.
But the other thing is, youknow, having some way for people
that when they're ready, whenthey're ready to make a good
choice, they have a way tofigure it out.
And that's where I thinkhealthcare really does a
disservice.
Speaker 2 (53:21):
You know, if she was admitted to the hospital, she
would be at the farm trying topick her own vegetables.
Speaker 4 (53:28):
Well, we some for another time, but I'd love to
have you as my guest and I'llgive you the personal tour of
our garden.
We have a huge community garden.
Food pharmacy, primary careattached to the food pharmacy
and huge community garden.
I've heard about that.
I'm very excited about thisFood pharmacy Yep, Primary care
attached to the food pharmacyand the community garden.
We do yoga, tai chi, we have aneducational pavilion, we have a
(53:50):
sizable farm and we have a foodpharmacy and a food pantry for
people.
So you come into our primarycare office and type 2 diabetic
and the doctor says you know,you're really only a type 2
diabetic because of your diet.
I'm going to give you a 12-weekprescription to our food
pharmacy and you're not onlygoing to be able to get food for
free, vegetables and all thegood stuff but we're going to
teach you.
(54:10):
We're going to teach you how tomake it and how to process it
Exactly.
Yeah, we do do that.
Speaker 3 (54:14):
We do See the beauty is is that, to your point, in
the way the system set up today,you're going to have a padlock
on your front door if you go allin on that at this moment 100.
I mean, that's the bottom lineright, however, there is.
You are at risk well, right, butno, no, and I'm not asking you
to become a payer but if youwent to pat garrity and said,
(54:35):
all right, I got 100 people thatI know are your people and they
want to come to my communitygarden and go to my primary care
position, get healthy, and myhealthcare delivery is going to
do that for you and I want apiece of the pie when I do it,
that's different than youbecoming a payer?
Speaker 4 (54:52):
No, no, I totally agree.
So I I look at if Pat wassitting right here and he is a
wonderful and, like I saidearlier, his organization is
great.
And we don't always agree, Imean, we definitely fuss at each
other, but we are completely inalignment.
You're absolutely right.
When people say to me are yougoing to become a payer?
You're going to go to it.
No, no, no, no.
Speaker 3 (55:11):
Not in my lifetime, right, and I'm not saying you
should, no but do I want topartner with payers?
Speaker 4 (55:17):
Do I want to collaborate with them?
Do I wish I had that kind ofrelationship with United and
Aetna that I do with the Blues,Absolutely I wish I had that so
do all of our clients I don't.
I have a very, very goodrelationship with Florida Blue
and it will remain very strong.
But yeah, you're right, I don'tbelieve, like a lot of health
(55:38):
systems and they do it for theirreasons and their reasons are
their reasons Not a lot ofhealth systems, and they do it
for their reasons and theirreasons are their reasons.
I I not a criticism of it, butI don't understand.
When a health system wants tobecome a payer, I don't get it.
We don't actually care forpatients appropriately.
Why would we get in?
well, that's a whole notherbusiness when we can't even do
the core business the way itneeds to be done?
(56:00):
Let's go master that.
Speaker 3 (56:02):
Right or figure out a combo.
Speaker 2 (56:03):
Well, there's a lot of me too-ism going on where you
hear stuff and like, oh geez,they're successful.
Why don't we have our ownhealth plan?
Speaker 3 (56:08):
That's a great point, I flew around the country
helping people start Medicare.
Advantage plans because youknow they went to some
leadership institute meeting andeverybody talked about it and
then everybody needed to havetheir health plan.
Speaker 4 (56:17):
You know how hard it is to run one of those things.
It is really hard we havethat's.
Speaker 3 (56:22):
John that has been the core of our business for
many years, is like helping.
And, to your point, the systemis not set up for those models
of care to succeed and do wellin that, and it's a.
It's a, so you have.
And culturally it's misalignedso you have to realign
culturally to be like.
Speaker 4 (56:42):
So anyways, we could like I know we've got, you know
we got to move on, but you knowwhat it brings us back to this
conversation.
Care coordination no it brings,it brings us, you bring.
If we should have that drinking, you know like if you?
Speaker 3 (56:55):
ever watch us, if you hear this word take this word
take a drink.
Speaker 4 (57:05):
It should be care coordination over my head, no,
but you know not that we'recondoning over drinking because
we're not.
We're not.
It's a healthcare podcast.
Right, we are not Drinkresponsibly.
But what it brings us back tois the concept of where the
federal government could play areally significant and
thoughtful role.
How about being a convener?
How about bringing all theelements and the parts and
pieces of the industry togetherto sit down and to really
(57:25):
collaborate and rebuild andretool a system?
Now, what my critics will sayis you're being completely naive
and you don't understand theindustry the way we think you
should.
I totally disagree.
I know this industry betterthan most and absolutely as good
(57:46):
as some.
Right, I mean I, I, I know theindustry, not perfect at it by
any stretch, which you'll findout on Monday, but with each
decade.
Speaker 3 (57:58):
you've got better.
With each decade I'm gettingbetter.
It's like wine, but truthfully,I've gotten better With each
decade.
I'm getting better.
You're getting close toperfection.
Speaker 4 (58:03):
It's like wine, but truthfully, I mean, people would
say, john, you're being naiveand you don't quite understand
how complex this is.
No, I know exactly how complexit is and I'm not being naive.
What I'm asking people to do isthink differently.
It's sort of like the reversemullet Think differently, behave
differently, not for the sakeof it, but the country is
(58:25):
depending on it.
If you don't have a healthy andwell society, you don't have a
strong country, you don't have astrong economy, you don't have
anything.
And I think there's anopportunity where you get payers
and providers and all differentaspects of the industry in a
room with venture capital,private equity, entrepreneurs,
(58:47):
real innovators, and you sitdown and say what does a system
look like in a free market,capitalistic society?
Speaker 3 (58:56):
What does it look like that meets people where
they are?
Speaker 4 (58:59):
That meets people where they are and that is
sustainable, exactly Right, andthat's reproducible and that's
highly reliable.
The answer is there, it's noquestion about it.
The lens that we're lookingthrough to see the industry
needs to change.
Speaker 3 (59:16):
So I have to come up, so you have to help me before
the 18th of September, so wehave a very quick time frame
here.
I am now dating this podcast,right?
Yeah, that's all right.
But I will be up at a Hill Dayand it's all about innovation
and I need to have an elevatorpitch on what we just talked
(59:39):
about today.
I have to like re-listen tothis elevator pitch on what we
just talked about today.
I have to like re-listen tothis because that's what I will
say.
At a bipartisan level, there isa desire societally to impact
this.
A hundred percent, and sothere's a lot of momentum in
different places.
But I really appreciate thatpoint around convening.
That's what we're missing.
Speaker 2 (59:59):
Your words helped paint a picture in this white
space behind me of what thingscould look like.
Speaker 1 (01:00:04):
So it's very inspiring.
The thing is and I'm bringingus in for a landing because we
need to, I know, because we have, because we could talk.
Speaker 2 (01:00:09):
It wasn't my fault that we didn't land the plane
yet.
Speaker 1 (01:00:12):
It wasn't my fault no , we usually well, we usually
close with this question thatyou essentially just answered
right, which is you have a bythe world, a coca moment, or
when pigs fly?
I think you're convening Idon't want to put words in your
mouth, but I think you answeredthat question when pigs fly buy
the world a coca I don't knowJohn looks like he's got to
finish.
Speaker 4 (01:00:30):
No, I think you're right, but I think it's very
doable, and you said something,ellen, that's important.
It's not a partisan issue, it'snot.
It should not be politicized.
The health and wellness of thepeople of this country should
not be politicized.
Speaker 2 (01:00:47):
Whether you're a.
Speaker 4 (01:00:47):
Democrat, republican, an independent or however you
identify.
When it comes to the health andwellness of the people that we
are responsible for in thisgreat nation, we should be
coming together andcollaborating and innovating and
building a new model, and notfor the sake of building a new
model, but because we need tobuild a new model, because we
(01:01:11):
are on a unsustainabletrajectory with healthcare costs
and quality.
And for the real cynicalistthing, the budget can't be
balanced unless you deal withthe Centers for Medicare and
Medicaid federally.
Yeah Right, it can't be no, andso we have to think differently
.
Speaker 3 (01:01:29):
Well, the trust fund is going to go.
I mean the trust fund is goingto be bankrupt.
Speaker 4 (01:01:33):
And my biggest fear is, somebody will come in and do
it for us if we don't do itourselves.
Speaker 3 (01:01:37):
Oh, you're 100% right .
Speaker 4 (01:01:38):
And we will not like what they do to us, we will not
like it.
I don't know what it would be.
I could venture to guess, butwe're not going to like it.
So right now is our time.
It's not 10 years from now,it's now, and so we got to get
after it.
So what is my when pigs fly,kind of thing, but I do think
this is achievable is whenyou're up in the hill.
(01:02:00):
It's how do you build somethingand how do you build a process
and a collaborative?
We're like-minded.
People from different parts ofthe industry come together to
build the new model ofhealthcare.
Speaker 1 (01:02:17):
Carter will love this so it's a, so it's a by the
world the Coke a moment.
Speaker 3 (01:02:21):
More so than pigs fly .
Speaker 1 (01:02:23):
Pigs will probably never fly.
Yeah, they probably will neverfly.
Speaker 3 (01:02:26):
Pigs flew a couple weeks ago, when they did in the
Simpsons too.
Well they also flew a coupleweeks ago when Epic announced
that people were going to beable to get their own health
data into apps as they wanted.
So there are pig flying moments, but anyways all right.
Speaker 1 (01:02:42):
Thank you so much for being here.
Thanks again, John.
Thanks for having me.
This is super fun.
I know it's rough on a Fridayafternoon.
Speaker 4 (01:02:47):
No, no, it's been great, thank you.
Speaker 2 (01:02:48):
We appreciate it.
Thanks again.
Speaker 3 (01:02:51):
Well, I'm Ellen Brown .
Speaker 2 (01:02:52):
I'm Justin.
Speaker 1 (01:02:53):
Politi and I'm Dave Pavlik.
We are the partners at.
As you can tell, we can talkabout this stuff all day.
Drop us a line.
We might even go down rabbitholes that are not at all listed
.
Speaker 3 (01:03:05):
Yes, exactly, but we are your best chance for real
change.
Speaker 1 (01:03:08):
We are your best chance for real change.
Speaker 2 (01:03:12):
Check us out at ep2healthcom.
Thank you.
Speaker 4 (01:03:13):
You guys are great you.
Welcome to the Reverse Mullet Healthcare
Podcast from BP2 Health.
Today we are in the studiotalking with John Kouros,
president and CEO of the FloridaHealth Sciences Center, about
world-class outcomes.
Won't bankrupt the individualFirst.
Who are we, why are we here and, more importantly, why did we
name our podcast the ReverseMullet Healthcare Podcast?
Speaker 2 (00:26):
Well, we want to be relevant, informative and
creative, but we also want to beentertaining and have fun.
So it's like a party in thefront and business in the back,
like a mullet, only reversed.
Speaker 3 (00:37):
We are your hosts and I do not have the wig on, so
you can't see it in real life,Ellen.
Speaker 1 (00:43):
Brown, justin Politi and Dave Pavlik.
We are passionate, innovative,collaborative and are committed
to solving some of ourindustry's most pressing
problems along with our clients.
We have a combined 90 years ofexperience.
Speaker 2 (00:56):
A bunch of old fogies we are.
Speaker 3 (00:58):
Speak for yourself, although I am actually older
than you.
So anyway, marginally, yeah,although.
Speaker 1 (01:03):
I am actually older than you.
So, anyway, marginally, yeah,anyway, and each episode we're
going to dig into a hot healthcare topic and potentially dig
into each other.
Just don't dig into me.
Speaker 3 (01:11):
Be gentle please.
Speaker 1 (01:12):
Yeah.
Speaker 2 (01:12):
Yeah, not chance.
We'll see about that, all right.
Speaker 3 (01:14):
Never, I can try at least Okay.
So I'm really excited to haveJohn back with us for a full,
full episode this time Back inJanuary, because I have to tell
stories right Back in January atJP Morgan.
Speaker 1 (01:28):
We do only have about an hour.
Yeah, it's not that long of astory.
Speaker 2 (01:32):
We'll do the Ellen abbreviated version, which means
it's six hours long, yeah asJustin said, it takes Ellen a
while to land the planesometimes.
So I'm going to land the planequick on this one.
Speaker 3 (01:41):
So I was at a Centerview Partners event with
some very, very impressiveleaders in our industry.
It was a variable who's who ofC-suite and I was asking
different folks.
I said who do you think are theunicorns in healthcare?
Who are the people inhealthcare that are actually
affecting real change?
(02:02):
With all caps right, becausethat's our thing and your name
came up three times in that roomto me like and this isn't like
conversation, you know goingaround the room and I was like,
well, now I have to meet thisJohn chorus Like, and the irony
is stalker.
Speaker 1 (02:15):
Yeah, yeah, yeah.
So the irony is you know.
Speaker 3 (02:18):
I'm in San Francisco for this event.
I happen to live in Florida andColorado.
My daughter goes to school inTampa and I'm thinking how have
I, how have I missed this?
Right, I've got it so.
So then we went back to Viveand we were recording episodes
and I, on the way in the plane,tagged you and said I want to
(02:39):
talk to some unicorns and JohnCorris, you're on my list.
And we talked and you came onthe podcast and and I I just I
really enjoyed hearinginnovation that you're working
on, um, and yeah, it was justkind of the story.
And you were like, yeah, I'llcome back and talk to you guys.
So here we are.
So I'm super pumped.
Speaker 1 (02:57):
I will also say that on the way here on the ride over
today, I'd listened to thatpodcast and I remembered that
when John walked in the room,first thing he said we had never
met him.
She just, by some stroke ofluck, he was going to be
available and was able to gethim to come down to the studio.
He walked in and he said y'allready to have the time of your
lives?
We said, uh-oh, why?
Speaker 2 (03:22):
yes, we are.
Speaker 1 (03:23):
Yeah, yeah, yeah.
Speaker 2 (03:23):
Well, I hope you can top it today.
I'll try.
All right, fangirl, that'senough, so let's take a few
minutes to actually introduceJohn.
He is the president and CEO ofFlorida Health Sciences Center,
which includes Tampa General, inpartnership with the University
of South Florida.
Under Coruscant's leadership,tampa General's footprint has
grown from 17 facilities to morethan 150 care locations
(03:46):
statewide, including sixhospitals.
He helped launch a venturecapital fund, tgh Ventures.
He is executing Tampa General'slargest master facility plan, a
$550 million capital commitment, by creating a growing medical
and research district indowntown Tampa.
He was recently appointed to athree-year term as a member of
the Florida Health CareInnovation Council.
(04:09):
Before joining Florida HealthSciences Center, he served as
president and CEO of JupiterMedical Center in Jupiter,
florida.
He also served in variousexecutive leadership roles at
BayCare Health and began hiscareer at MassMGH.
Roles at Baycare Health andbegan his career at MassMGH.
So Coris is a graduate of BUand holds a Master of Science in
(04:30):
Management from LesleyUniversity in Cambridge,
massachusetts.
He holds a doctorate inbusiness administration
management sciences from theUniversity of South Florida
College of Business, where he'sa research fellow.
His dissertation examined theimpact of the practice of
authentic leadership on teamsand organizations.
He's a proud husband and fatherof two children, and his
professional accolades read likea compendium of who's who in
(04:53):
leadership, healthcare,innovation and thought
leadership Another classicunderachiever.
Speaker 3 (04:57):
Yes, and just for the record, I had to cut the
accolades because it literally,I think, would have taken the
entire episode to read them all.
Speaker 4 (05:04):
That's my staff who I still list it all out.
Speaker 2 (05:07):
So you were in Boston for a long time.
Yes, all right Did you everwatch?
Speaker 4 (05:17):
see Little Joe Cook at the Cantab.
No, who's Little Joe Cook?
Speaker 2 (05:19):
He was an institution Cantab was a Cambridge mass bar
and Little Joe Cook was a bluessinger and he was there for
years.
Speaker 4 (05:27):
So a bit of an institution, yeah that's
Cambridge, though that's thePeople's Republic of Cambridge.
It's very different from thecity of Boston.
Speaker 2 (05:38):
It is that area of Leslie, right near Harvard
Square, walking distance.
Did you say Harvard Square?
So that's the other one.
You like apples, don't you?
I do?
I got her number.
How about them apples?
Speaker 3 (05:53):
What he just pulls them out Good Will Hunting.
Yes, yes.
Speaker 4 (05:59):
Oh, wow, wow.
Just saying I'm going to bringyou with me on trivia next.
Speaker 3 (06:05):
You would win with this one.
Speaker 1 (06:07):
You talk about some obscure references.
Speaker 3 (06:09):
Keep going, you got any more so.
Speaker 2 (06:13):
We could probably talk all day, you guys are in
Boston, yeah.
I lived in Alston, then movedto Watertown Square, waltham,
and then subsequently movedfurther, crossed the border
eventually into New Hampshire notax land.
I'm from Swampscott.
Speaker 4 (06:32):
Massachusetts, just to the north of the city by
about 15 miles.
You still have family there.
My whole family is still in NewEngland.
Okay, most of it.
Speaker 2 (06:40):
Most of it.
So we're in Salem, NewHampshire now.
Speaker 4 (06:43):
Yeah, I know it.
I went to school high're inSalem, new Hampshire.
Speaker 2 (06:44):
Now but yeah, I know it, it's a school, high school
in New Hampton.
Speaker 4 (06:47):
Yeah, In New Hampton, new Hampshire, right off.
Speaker 2 (06:49):
Lake.
Speaker 4 (06:50):
Winnipesaukee.
Speaker 2 (06:51):
Yep.
I used to live in LakeWinnipesaukee, apogos Bay, south
Down Shores.
Speaker 4 (06:56):
Meredith New Hampshire.
Speaker 1 (06:59):
Is Good Will Hunting the Beautiful Mind, a beautiful
mind movie no that's different.
Speaker 3 (07:03):
No, but there is a good, beautiful mind aspect.
Speaker 2 (07:05):
with that solving equation, there is a beautiful
mind aspect.
Speaker 4 (07:09):
But wrong movie, wrong state.
Speaker 3 (07:11):
He just likes to bring it up so they can make fun
of me, because they make fun ofme trying to make a connection
and I screwed it up.
Speaker 1 (07:16):
I will edit that out, potentially.
Speaker 3 (07:18):
All right, last bit of the fun You've hiked Machu
Picchu.
Speaker 4 (07:23):
I did.
I did back in gosh when I wasin high school.
Speaker 3 (07:28):
And not a repeat item for you.
Speaker 4 (07:32):
No, not a repeat item .
Check that off the list.
It was kind of cool, it was alot of fun.
I'm glad I did it.
We went up to Wainu Picchu too.
So if you've ever been to MachuPicchu, there's the Inca city
and whatever the town.
But there's another peak and ontop of it is a temple dedicated
(07:58):
to the moon and the sun and youcan climb up that.
It's not a long hike but it's avery steep hike.
That's kind of a neat thing todo.
It's not a long hike but it's avery steep hike.
That's kind of a neat thing todo but it's a one and done.
Speaker 3 (08:08):
But that kind of probably was the nail in the
coffin on that one like theextra steep.
Speaker 4 (08:13):
It was the one and done for me.
Speaker 3 (08:16):
But so, in good news, though, the last time we talked
you were headed to London andCroatia.
Yeah, it was awesome.
Speaker 4 (08:20):
Was it?
Did it top Rome?
Yeah, it was awesome.
Speaker 3 (08:21):
Was it?
Did it top Rome?
Speaker 4 (08:24):
Very different.
So I would highly recommend wewent to Croatia, to Dubrovnik,
we went to Montenegro and wewent to London.
I would highly recommendCroatia and Montenegro, and
London is one of my favoritecities in the world.
It's wonderful, but Croatia isa definite.
If you haven't been, you got togo.
Speaker 3 (08:47):
It's high on my list.
So I was.
I was very.
I was like, oh, we're going tosee John and I get asked him
about Croatia.
Speaker 4 (08:50):
It's like a less expensive version of Italy.
Speaker 1 (08:54):
So you said you loved Rome.
How does, how do you comparethe two?
I think they're very different.
Speaker 4 (08:59):
Italy is such a special country and Rome is just
this incredible city, as youknow, um totally different,
totally different, you know.
I mean like croatia was formeryucoslavia, right?
So it's you, you know, croatia,um montenegro, they're still
developing.
(09:19):
Yeah, you know, in a crazy way,even though it's it's been a
while since the 90s, they'restill developing.
So it's very, very different.
I mean, in Rome, you feel likeyou're stepping back in time,
right?
You really feel like you're.
Well, you are right, right, youwalk in that.
Speaker 3 (09:34):
Colosseum and you're like wow.
Speaker 4 (09:36):
Wow, this is like the real deal, yeah, yeah very
different Okay.
Speaker 3 (09:45):
Well, I'm going to have to.
You're going to reel us in.
I'm going to be the guy You'removing from the party in the
front, all right.
Speaker 1 (09:47):
Yeah, I'm going to slide us into the business in
the back part, but I'll do it ina fun way.
We took failures.
We're going to talk aboutfailures again.
You made headlines when yousaid we don't do pilots and
celebrate failure.
When you were speaking at themain stage on vibe, where five
where we, where we met you andthen we, we first met we started
(10:11):
to scheming, we started shouldI say scheming?
Is that the right word?
Speaker 3 (10:14):
I don't know, it has a negative implication, but I'm
going to stick with it.
Speaker 1 (10:18):
We were more.
We were more spitballing theidea of a failures of a failures
conference.
Speaker 3 (10:24):
Yes, yes, so tell us your thought on that.
Speaker 4 (10:29):
Well, I'll tell you what after Monday, when I test
drive the concept with yes, withEllen.
I will be there with you.
We'll test driving together.
But Ellen and I are going totest drive it together and it's
going to be kind of neat becausewe're going to do it on a
podcast, we're going to do itwith podcast, we're going to do
(10:50):
it with, I think, 100, 150, 200people in the room and we're
going to go decade by decadeabout, um, my failures and
mistakes.
So it's sort of a combination.
So it's a mix between a projector two that has completely
failed and why, and then whatdid you learn from it, or what
did I learn from it.
But then there's also theleadership.
You know mistakes along the way.
So I'm excited about doing itand if it goes well which I know
(11:13):
it will, because Ellen isemceeing I think we should turn
it into a conference.
Speaker 3 (11:20):
I agree.
Speaker 4 (11:22):
Everybody I talk to about a failure conference.
Even if it's for like two days,people love it.
Yeah, everybody loves theconcept.
Yeah, I mean going to a normalconference and hearing about all
the good work that's being donearound the industry is
wonderful and it's important andit's seeing those conferences
are significant.
(11:42):
But literally going to aconference and only hearing
about failures and mistakes Ithink that's where the deepest
and richest learning comes from.
Great, so I hope Monday will gowell and it's well received.
Speaker 3 (12:01):
And if it is, then we need to make it happen.
We're in, yeah.
Speaker 1 (12:03):
It's going to be great.
You've got to find leaders thatare willing to check their ego
right the door.
Come in and be humble right.
Speaker 2 (12:13):
That's why it's rare to find a leader that celebrates
failure.
Speaker 4 (12:16):
Well, when I went through all my failures and was
preparing earlier this week fornext week, I cried myself to
sleep.
After the one session I hadwith my chief of staff and my
vice president of corporatecommunications, jennifer
Crabtree who's wonderful, welove Jennifer I was like I'm
laying in bed.
(12:36):
I'm like I should be weepingright now.
You know, but I'm reallyactually looking forward to
sharing it, cause I think when,um when people don't think they
make mistakes or are unwillingto share mistakes, I think
that's a huge missed opportunity.
I do, and I think there's a tonto be learned, so I'm excited
(12:59):
to share them.
Speaker 3 (13:00):
I'm excited.
I think the other thing too isI've had such an immense respect
for your philosophy on failure.
Partly it's near and dear to myheart because we have an
individual who was a client ofours for a number of years.
Honestly, if I had to line upunicorns in rank order in
healthcare but on thetraditional side, there's a
(13:23):
bunch of really innovative stuffover here that point solutions,
their ideas, their disruptors,but they're not managing the
day-to-day of healthcare, theunderbelly of it.
That's a hard place to live.
It is a very difficult placeto—a lot of people like to point
fingers at institutions and sayyou're the reason.
This is a system we built.
(13:45):
We should be much moreappreciative of what's happening
there.
This particular individual wasprobably the most disruptive,
willing to take the most boldrisks, but calculated risks.
That person ended up.
They're not in the industryright now because the bet that
(14:06):
they made the partner that theychose wasn't holding up their
end of the bargain and thatreally hit like.
I had a hard time with that andI think it's important.
It's like wait a minute, thoughthat was a what?
If that risk had paid off, thatcould have been game changing
for the industry.
And now we lost that personbecause of that one thing.
So anyways.
Speaker 2 (14:27):
So how do we tolerate or find some level of balance
between accountability andadmitting mistakes?
Obviously, we want to begetting people to be encouraged
to take chances and risks, butwe have this in our society that
if I do that then I have a riskof getting fired, and so I'll
kind of stay in my lane and notdo that.
(14:48):
What are your thoughts on that?
Speaker 4 (14:49):
Well, I think it starts with like creating a
culture that sort of encouragespeople to take chances and to
make mistakes and to celebratefailure and to do the things you
need to do.
So in my world it's reallysimple.
(15:11):
We've got four key attributesto sort of the world we live in.
We lead and treat each otherwith authenticity, so we are our
authentic selves.
We don't try to be somethingthat we think the organization
or other people want us to be.
We sort of embrace who we are,even with all our idiosyncrasies
(15:34):
, right.
So authenticity createsrelatability.
Relatability creates trustright.
In a lot of cases, we also leadand treat each other with
kindness right.
In a lot of cases, we also leadand treat each other with
kindness right.
So we spend a lot of timetalking and understanding what
kindness is, what empathy is,what love is, and we lead that
(15:55):
way, we treat each other thatway.
As you lead people and treatpeople and build an environment
where people are treated withkindness and love and empathy,
you create psychological safetyin a really significant way.
The third aspect of our work andhow we do it, to answer your
(16:17):
question, is we lead and treateach other transparently.
We share almost everything.
The only reason I say almost isbecause, of course, if there
are things that need to beconfidential, if it's an
employee issue or a team memberissue, excuse me.
So if it's a team member issue,if it's a patient issue, if
it's a delicate strategic issue,of course we're going to keep
(16:40):
those confidential.
But most everything we do welay it out there for team
members.
We hold very little back.
And then finally and that buildstrust that builds big time
trust, because no one likes tooperate in the opaque.
I mean, if you've ever workedwith somebody or collaborated
with somebody or worked forsomebody who isn't transparent,
(17:02):
it's very distracting andlimiting.
And then finally, we lead withvulnerability.
We show real vulnerability likeI don't know something or I
made a mistake right or I askedfor help.
That's vulnerability.
When you start to do thesethings on a consistent, everyday
basis and it becomes part ofthe DNA of the organization,
(17:26):
you're able to sit in front ofhundreds of people and talk
about your failures.
You're able to talk about yourmistakes.
Why?
Because you know that theorganization isn't going to
judge you, that the organizationwill embrace it, celebrate it,
learn from it, move on from it,grow from it.
So that's how we do it.
(17:48):
It's not supernatural, it justis very intentional, deliberate
work.
Speaker 1 (17:53):
It's a culture you built.
Speaker 4 (17:54):
Yeah, it's a culture we built and, believe me, we
work on it every single day.
Speaker 3 (18:00):
You have an acronym for it and you wrote a case
study on it.
Right, we did.
Speaker 4 (18:03):
It's called ACTIV Good, great memory.
Look at you with your notes.
I didn't even look at my notes.
I remembered it.
Speaker 3 (18:09):
You were talking about it and I was like he's
describing ACTIV.
Speaker 1 (18:13):
And I was going to ask him about that later, what
does it stand for?
Speaker 3 (18:17):
He just gave you all the words.
Speaker 4 (18:25):
It stands for leading with authenticity, kindness,
transparency and vulnerability,and you put those words together
and it's active.
It's something we train on.
So every leader and every teammember in the organization is
trained on this.
We are constantly talking aboutit and using it and socializing
it.
We hold each other accountablefor it and in a rare occasion
when a leader struggles with itand gets to a point where you
(18:49):
have to make a determination arethey unwilling to adhere to
active or are they incapable ofadhering to active, or is it a
combination of both?
They got to leave.
I mean, we're, we're, we'rereally very committed to it.
Speaker 3 (19:05):
It's impressive and you did so.
I'll just stick with this, Iwon't.
You know, the whole point ofthis is to be able to have a
conversation is so, but you'reso passionate about it, not only
do you lead that through yourorganization, but but you
actually wrote.
You wrote a peer reviewed likethere is.
There is a peer reviewed studyon the efficacy of this approach
(19:27):
right that you published thisyear.
Speaker 4 (19:30):
Well, actually true.
So the active model came frommy dissertation and my doctorate
program.
Yeah, so it's a verywell-studied, very
well-researched and there's lotsof data that shows that what
I'm sharing with the audienceactually works.
And when people say well, whatdoes that mean?
It works Well, it has improvedteam member engagement in our
(19:51):
organization significantly.
I mean we operate with teammember engagement well above the
national averages and um inteam member engagement.
I mean well above it.
Like always, we're always inthe top quartile or decile in
engagement.
It has created an environment ofpsychological safety.
You cannot innovate and createif you don't feel safe in the
(20:14):
environment.
You're doing that, you can't,or you can't do it as well as if
you were in an environment thatfostered all of that.
And then, finally, it buildstrust.
And then when you can have anorganization that feels safe,
feels protected, and you have anorganization that's completely
(20:34):
engaged and you have a team ofpeople that trust each other,
your performance is you becomeunstoppable.
See what's interesting aboutour industry.
I say this to my chiefadministrative officer, who has
the strategy group reporting.
To her I said you know everyhealth system, or most health
(20:57):
systems.
Maybe there's super enlightenedhealth systems and in in the in
in our industry.
But most health systems um, wethink our strategies are novel
and they're different and unique.
They're not.
They're all variations of atheme.
You travel the country, youtalk to all of us in the
industry and we talk about thesame things.
(21:19):
We're going to build hospitals.
We're going to build out anambulatory network.
We have to do more inpost-acute.
We have to do better with ourteam members.
We have to recruit morephysicians.
We have to do more inpost-acute.
We have to do better with ourteam members.
We have to recruit morephysicians.
We've got to build more stuff.
We've got to expand ourfootprint.
Now the configurations aredifferent and there's slight
variations to the general theme,but it's basically the same
(21:40):
strategy across the country.
What is very different fromsystem to system?
People, culture and anorganization's ability to
execute a plan.
Speaker 3 (21:53):
Absolutely Very different Very.
Speaker 4 (21:56):
Our secret sauce in TGH and USF is not the actual
strategy, it's our people.
I'm unbiased, but I'm also arealist.
We have some of the best peoplein the industry.
I'll put my team up against anyteam in the country and we will
out-execute any team in theUnited.
Speaker 3 (22:17):
States.
So I'll give a, because I haveinsider information right now
that nobody else knows?
In preparation of Monday is andsee we have trust.
I can see we have built trustbecause you didn't look at me
across the table like, oh, goodLord, what is she going to say?
Was I thought the learning thatyou had from your decade at
(22:40):
Jupiter Medical.
I feel like that really feedsinto your ultimate commitment to
how you lead now.
Speaker 4 (22:46):
A hundred percent.
Speaker 3 (22:47):
Right.
I thought that was reallytelling was I was the one that
controlled it.
I held onto it tightly and then, when I left, it all fell apart
, and so I love sitting hereknowing that that was, in your
mind, a failure, that now, inthis next decade, you've done
completely differently.
I just needed to practice forMonday.
Speaker 2 (23:07):
Maybe you could give Bill Belichick some advice.
Speaker 4 (23:10):
Yeah, right, right, right.
No, I did.
I mean the Jupiter experience,just to foreshadow a little bit
of what Monday is going to be.
I mean, the Jupiter experiencewas a mistake.
I wouldn't characterize it asan out-and-out failure, because
the institution did extremelywell and and.
But when I left, when I I waswatching all sorts of things
(23:33):
online, and when one of my boardmembers you know because they
were coming to me and saying,well, we need help with this,
what do you think about this,what should we do here?
And you know I love the place,so I was totally available and
willing to help and guide andprovide whatever information I
could.
But I was shocked at howquickly some things not all
(23:56):
things, but some things justunraveled.
And I actually said to one ofan old board member of mine I
said, well, what, what's goingon?
He said, well, john, and thiswill be like the cliffhanger he
said, john, you're the leader.
We were all on a path that youhelped create.
(24:19):
You're leading us down the path.
And when you left the path, weall stopped walking the path and
said, well, what do we?
What do we do now?
Yeah, like what?
Okay, so what?
What do we do right now like wehave a plan, but john was our
leader driving the plan we werefollowing john leader and john.
(24:40):
Right, we're following john.
Maybe not the plan, maybe wedidn't understand the plan, but
we trusted John and I didn'tthink like I thought I was
educating them on the plan.
I probably wasn't educatingthem to the extent that I should
have or could have.
(25:01):
It wasn't done intentionally.
I thought I was doing it, but Iwasn't doing it obviously
enough or the right way in thatparticular case.
And so when I left, stuff thatwas just grounded in great
analytics and just good planschanged and it hurt the
(25:21):
organization, hurt theorganization and my.
The coaching I got from one ofmy board members was well, it's
not anything like.
His comment was oh, you didanything wrong.
You just made a mistake, youdidn't you?
You thought these folks werecoming along more than they were
and they weren't Yep, yep.
Speaker 1 (25:42):
This has given me a new appreciation for well, I
should say, my.
My wife is a human resourcesleader at a large health system
in northern Virginia and thething that she's always the most
proud of is when they get thoseengagement scores.
And you know, I don't know ifthey have something like active,
but certainly the pillars, thepeople pillars.
Speaker 3 (26:01):
I bet Sarah is going to learn about active whenever
you see her again.
Speaker 1 (26:04):
I might tell her yeah , you know why not Share the
wealth?
Speaker 4 (26:08):
Yeah, but it's given me a new appreciation for what
she gets so excited about allthe time.
Speaker 3 (26:19):
It's all about the people man, absolutely Well, so
okay, so I am going to take usto the question.
Really, the platform purpose,the passion purpose of this
whole podcast, is to bringthought leaders like you, john,
to your point.
Variations in theme.
But I think what we don't havea chance to do, I think we spend
so much time in our lanes andin transactional conversation
(26:40):
and in operational details thatwe lose the opportunity to have
true non-transactionalconversation about how to affect
real change in all caps.
And you were cited.
I really liked you saying whenwe were prepping for this
episode, you said because youknow I have this passion for I
(27:03):
want to see us reverse lifestyledisease and I'm not talking
about prevention and wellness,you and I have clarified that.
But I really liked your pointof like hey, I'm doubling down
on care coordination, my job isto help you when you are sick
and I think that's a really goodline to do.
And and so you were quoted in ahealthcare business day article
(27:24):
recently.
You were interviewed in part ofa thing and you said we need to
do a better job as an industryon care coordination, patient
experience, access andconvenience.
And you went on to say we arecreating a healthcare ecosystem
that provides a frictionlessenvironment for our patients,
physicians and allied healthprofessionals.
Tell us your vision and ifthat's not your vision of real
(27:45):
change, you can change the topic.
But you know, as we push thingsalong and it can be incremental
, but you know what's that kindof push to make a difference
when people complain abouthealth care or whatever.
Speaker 4 (27:59):
Well, it's a great question.
I mean, we're on anunsustainable trajectory in
health care?
Speaker 3 (28:04):
Yeah, absolutely.
I mean.
We're on an unsustainabletrajectory.
Speaker 4 (28:06):
Yeah, absolutely.
I mean, you know, 17 to 21% ofthe GDP is spent on healthcare,
depending on the year, and itdoesn't really go lower.
It's kind of stuck there andinches up.
You look at quality, you lookat clinical outcomes.
You look at the most recentCommonwealth report, which is a
wonderful report to look atbecause it's not a partisan
(28:30):
report, it's sort of like just areport on health care and you
look at our quality compared tothe other 10 or 11 largest
industrialized nations in theworld.
There's lots of reasons forthis.
We're like dead last at almostevery quality indicator.
(28:51):
Now, don't get me wrong.
There's wonderful work beingdone around the country by
really incredible and specialhealth systems, but we're not
moving the needle.
Health and wellness isn't goingto do it, not in our lifetimes,
not in our lifetimes and maybenever.
I think health and wellness isa component of care coordination
, but I don't think it's thebusiness that we're in.
Speaker 3 (29:12):
At least the sector of the business that I'm in.
That point to me is what Ialways kind of go back to is and
I experienced it with my momshe actually had almost died a
year and a half ago at JupiterMedical Center.
So thank you for the work thatyou had done, because it is a
really good facility.
You've taken very good care ofher twice.
(29:33):
But I walked out of thererealizing you go to the hospital
to be kept alive, you areacutely ill, you are
experiencing an acute incidenceof sickness.
There's something really wrong,right, and you're going to the
hospital to be kept alive and tonot be sick.
The job of the hospital is notto make you healthy, and I think
(29:56):
that's where we go kind ofwrong as a system is.
We really have not builtanything for that To teach
people and help people how to behealthy.
We expect them to just figureit out.
You know and I don't want to, Idon't want to answer that right
now, but my point is I agreewith you that that we have built
a system for what it's intendedto do, which is you're really
sick, we're going to help you,right, and that's what that's
(30:18):
your job Like.
That's that's what you're askedto do and you're tasked to do.
Speaker 4 (30:29):
That's right, and we struggle with it across the
country.
Yeah, so why would we get intoother aspects of the business if
we can't figure out the corecompetency of the business, if
we can't figure out the mainreason why we exist?
All this diversification?
And I'm going to be a healthand wellness platform, I'm going
to be an insurance company.
I'm going to be verticallyintegrated.
Well, wait, I'm going to be aninsurance company.
I'm going to be verticallyintegrated.
Well, wait a minute, we don't dothe core work well enough.
(30:50):
As an industry, we don't dothat work well enough.
So when people say, well, whatis that work, john?
It's care coordination.
It's coordinating care, it'seliminating friction, it's
eliminating silos, it'seliminating that fragmentation
that exists in the system andthat drives quality down and
(31:12):
increases cost.
In any other industry wherethere's friction, where it's
disjointed and clumsy, it addscost and it doesn't create value
for the consumer.
So what do other industries do?
They fix it.
We struggle with that.
We do.
And it's not an indictment onthe industry, because I'm a
(31:35):
product of the industry.
I have nothing but a ton ofadmiration for my colleagues
that are trying to figure it out, just like I am.
Just don't think as a totalindustry.
We've embraced the concept ofcare coordination.
Speaker 1 (31:49):
But most organizations will tell you we
do care coordination, we dopopulation health.
Speaker 4 (31:54):
So what I mean about care coordination.
I wrote about this.
It was actually published in amodern health care magazine in
like a two-part series.
We published it in a two-partseries.
The title was sort of Untyingthe Gordian Knot of Healthcare.
Care coordination is kind ofthe way.
And the reason I wrote the paperwasn't because I thought I had
(32:16):
great, you know, knowledge tobestow on the industry.
It's just that when we startedto socialize care coordination
at my health system, everybodyhad a little different idea of
it and they were running offdoing all sorts of different
things and I wanted to bringeverybody back and focus them.
So I basically wrote, with ateam of people, a manifesto that
(32:40):
said this is care coordination,this is our rallying cry, this
is our true north.
So care coordination to me it'snot population.
Health Care coordination to meis a fundamental shift in the
healthcare systems operatingsystem.
So it's like building an iOSsystem for healthcare, like
(33:05):
Apple has on their phone andwhat I tell people all the time
because Apple most of us canidentify with it.
I said what makes Apple great,it's its operating system, it's
not the phone, it's not thetablet, it's not the computer,
don't get me wrong the phone,the tablet, the computer, the
earphones they're pretty cool,they're well-designed, they're
well-constructed.
They're earphones they'repretty cool, they're well
(33:26):
designed, they're wellconstructed, they're fun,
they're hip.
They're all the thingseverybody wants, but the
stickiness.
The reason why people loveapple apple will tell you this
is their ios system.
It is a closed loop system thatboth designers and developers
(33:46):
and users and consumers coexistand when you're in the ecosystem
it's reliable, it's safe, it'sintuitive, it's friction, light
or frictionless.
It's not siloed and fragmented.
It applies sort of a systemsthinking to how they deploy it
(34:08):
and how people either create init or are users in it.
Why can't we create anoperating system like that for
healthcare?
That's care coordination to usat TGH and at USF, no, it sounds
very.
Speaker 2 (34:23):
It's exactly what we've talked about in so many
different instances of like.
You're the type of entity thatif I was a payer, I'm saying.
A lot of payers have their ownlike idea of what care
coordination should or shouldn'tbe, and there's a lot of
overlap.
But why can't I just delegateit to you?
If you are doing all of thisand do it on behalf of all of my
members, right, we pay you forcare coordination.
(34:44):
If we all align to say this isthe right direction.
That's pie in the sky, I get it, but there's a lot of overlap
in care coordination going on,because we're all confused in
the industry right now.
Speaker 4 (34:55):
Providers think they're payers and payers think
they're providers, and then theygo.
And don't get me wrong.
I mean there's great businessmodels.
I mean, look at United Optum,they print money.
You just look at UnitedOptim,they print money.
Okay, you just look at theirstock, look at what they're
(35:16):
doing, look at the money they'veaccumulated.
They do a great job.
Now I don't think they shouldbe in the provider piece.
They're in the provider spacebecause they want to retain
first dollar coverage as much asthey can in their own system.
They're not trying to save theworld, they're trying to build
and they've built a businessmodel that is very lucrative.
That's why they're doing it.
So why not pay or be a payerand get into health and wellness
(35:42):
, get into the front end of thatjourney for your beneficiaries,
but then help and partner withus as providers.
Get into health and wellness,get into the front end of that
journey for your beneficiaries,but then help and partner with
us as providers.
That doesn't happen in thisindustry.
Speaker 3 (35:53):
No, it's very overlapping.
I think it gets back to theeconomics.
The economics are verymisaligned and very disjointed
and sort of removed.
You don't have a choice.
Our health care dollars areinvested on our behalf.
I mean, I happen to have my owninsurance so I can pick, but
it's not like there's some grandplan.
(36:14):
There's a limited choice ofoptions of what's going to be
covered for me.
So our healthcare dollars areinvested for us and they're
invested into a system that's tokeep me from dying, into a
system that's to keep me fromdying.
It's not.
It's not meant to keep methriving, it's not.
That's not the system we built.
And so I think you know we, weneed to start, we need to step
up to the plate and own that.
(36:35):
That like if I want aworld-class institution to go to
, if I am on death's door or Ihave something really wrong with
me, then I want to go to TGHand know I'm going to get taken
care of and then I'm going toget the best care and it's going
to be coordinated.
I'm going to be.
You know what I'm saying.
Then you're going to dischargeme and say, okay, now if you
(36:56):
want to get healthy again,that's go do it, you know what I
mean.
Speaker 4 (36:59):
Like that's not your role or partner with people that
can do it, I mean look, we havea really, really great
relationship with Florida BlueGuidewell.
Speaker 3 (37:09):
Shout out to Lee Bowers Medicare.
Speaker 4 (37:11):
We love Lee, that's right Pat Garrity, who's the CEO
and the president of the wholething Excellent, great visionary
, great guy.
His team's wonderful.
We don't always agree.
There's plenty of times we fussat each other, but we're great
partners because we both kind ofbelieve in the same thing but
look at it a bit differently.
Speaker 3 (37:33):
You own your spaces.
Speaker 4 (37:34):
We own our spaces.
He does have clinics and doesprovide care, but he does it in
certain markets where it'sextremely expensive and he feels
like he needs to do somethingdifferent.
That's his prerogative, I think.
Personally, I think it takesmore time and it's more work,
but I'd spend more timepartnering with health systems
(37:57):
and I'd spend more timepartnering with folks.
But he's a great partner andhe's a wonderful guy.
We have a wonderfulrelationship with Lone Blue.
We collaborate on all sorts ofthings.
They teach us the payer world.
We teach them a little bit ofthe provider world.
We sit down and we try toinnovate together.
A great example is Pat and histeam, florida Blue.
(38:19):
They were the first commercialpayer that we had that actually
paid us for hospital at home.
We had commercial payer that wehad that actually paid us for
hospital at home.
It actually started acommercial plan with us that
provided us a commercial plan.
I mean that's great.
Those little innovations really, really matter.
But again, there are a few.
(38:41):
There's very few of thosepeople out there.
I'm telling you this is just myperspective.
It's a little weird.
Like I said, you've got payerswanting to be providers and
providers wanting to be payers,instead of sitting down and
saying there's got to be abetter way.
Speaker 3 (38:57):
Right, I'm delivering .
But see, I'll just add that Ithink ambulatory care is where
it gets a little muddy andeverybody's kind of chasing,
because to me that's the area,that that's a connector, right
Cause it's like, okay, I cameout of the acute care setting,
I'm not ready to just be at home, I've got to enter this sort of
ambulatory space, right, or I'msick, but I'm not acutely sick,
(39:21):
right, and.
And then the problem is that ifthe health system is just
focused on the acute, but theywant to be able to feed by using
ambulatory their focus is onthe acute then they're not going
to do ambulatory well, so thenthe health plan says wait, I
need ambulatory.
You know what I mean.
So then it gets this like muddyground and the sad part is that
that's actually where there's alot of money to be made and
(39:44):
whoever's going to own thatperson in terms of trying to
minimize their touching into thehospital system you know what I
mean.
Hitting that acute care point,somebody needs to help navigate
that, and that's where I thinkpeople overlap.
It's like people are bumpinginto each other and it comes
back to who's financiallyaccountable, which is what I was
saying about the economicsbeing yeah and part of it is
(40:05):
both sides.
Speaker 2 (40:06):
Well, on the payer side basically thinks that you
know, wait, the health system'snot necessarily focused on
making sure that they're mostcost efficient as possible.
So we are going to start todeploy resources on our own to
do something to help mitigatethat right.
And then all of a sudden, youhave all these barriers put up
that the care access that docreate that friction right.
(40:28):
So you know, priorauthorizations, all those
components that just are hurdlesto actually implementing a good
model.
Speaker 4 (40:36):
Yeah, you know the federal government needs to
create an environment where theybring us all together to really
collaborate and build a newmodel.
The way we're doing it doesn'twork.
And, by the way, for thosepeople that think, well, the
solution is a one-payer system.
Let the government take it over.
That would be an absolutedisaster.
That would be a disaster, and Ihave strong feelings around it
(41:01):
because it's not political, it'sjust look, if you look at what
Obama did in Obamacare, did ithelp?
Yeah, it probably helped, butit hasn't improved quality.
It hasn't improved clinicaloutcomes or safety.
It's increased access, but allhe's done is create another pool
of underinsured people.
(41:22):
Okay, so what he's created froman economic perspective is a
bigger burden on the healthcaresystem, because when you're a
Medicaid patient, you're paid atsome version of a Medicaid rate
.
In Obamacare, you're justunderinsured.
Right, you just don't have,you're not appropriately insured
, and when you vilify the healthsystems and say, well, you're
(41:43):
too expensive.
Speaker 3 (41:44):
Well, that's, somebody has to pay for that
care.
Speaker 4 (41:46):
Yeah, but it's ridiculous because it's not the
health system's fault, right,just like it's not completely
big pharma's fault or thepayer's fault.
What our government needs to dois create an environment, hey,
where you can innovate, you cancollaborate, you can partner.
How about being incented to dothose things to build a stronger
and more resilient and morehighly reliable system for the
(42:10):
people of this country?
That's what our federalgovernment should be doing.
They should be facilitatingthis.
They should be driving ustowards this kind of creativity
and partnership.
Instead, what do we do?
Our special interest groups runaround and we vilify each other
, I agree, and nothing getschanged.
Speaker 3 (42:29):
I know, and what's interesting is, you know, when
you talk about Obamacare.
I mean, one of the things thatcame out of that was CMMI, which
is the Innovation Center forCMS, and they've launched 50
value-based programs and wecould knock them until the cows
come home and those specialinterest groups love to bash it
right.
It becomes this partisan issueof like-.
Speaker 2 (42:47):
Both sides, both sides bash.
We want it to go away and thenwait.
Speaker 3 (42:51):
This isn't saving anything, but to your point it's
actually a learning lab for newmodels, and you know what.
So what if it didn't save money, if it kept costs neutral?
We've flip and learned from itright.
And so I agree with you thatit's like we have to invest in,
in collaboration and and and arealignment, like I'm very
relieved to hear you say like itdoesn't work the way it is
(43:13):
today, cause a lot of healthsystem CEOs are like, well, I'm
doing this or I'm doing that andit's going to get better.
And it's like, no, we, we havebuilt a system upon which volume
is how you're paid and youcan't fault anybody for that.
Like, why would you want tostep up?
Speaker 2 (43:27):
and I mean you know, we're given false choices too
when it comes to this stuff.
Right, when I say that issuesare brought up and it's like
well to your point, right?
Well, we should just be singlepayer and everything like this
is going to go away.
No, that's not an accuratestatement, or we need to like
this whole concept of like.
Why aren't we working togetherand the federal government and
sending these, like everybody,to get together in a more
(43:47):
functional system, versusputting out false choices for
people and putting in their own?
Speaker 4 (43:52):
Be a convener, the federal government, convene us,
bring us together, drive us.
Instead of driving us apart,yeah, instead of driving us
apart, no.
But, ellen, it's a great point.
Listen, under PresidentKathleen Pasadena's Live Healthy
Act, she's created a 15-personinnovations committee where we
are going to take real problems.
(44:14):
I was appointed by her for thiscommittee.
We're going to take realproblems, real problems.
We're going to present them tothe industry and say innovate.
So, venture capital, privateequity entrepreneurs, health
systems OEMs, original equipmentmanufacturers, companies, come
to us with a solution to ourreal problem and let's let
(44:38):
innovation drive theimprovements in healthcare that
we have to make across the board, I might add, from the provider
side to the payer side andeverything in between I'm really
excited about this, you had meat healthy.
Yeah, well live healthy.
Speaker 3 (44:56):
I understand.
Speaker 4 (44:57):
But what, kathleen?
What the President Pasadena didis she enacted a ton of policy
over the last year to improvethe resiliency of the healthcare
system in the state.
Along with the governor andalong with the speaker of the
house and along with thoselegislative bodies, they're
created a body of policy that isactually going to if
(45:23):
implemented right and notmorphed into something and
picked apart and criticized, andall that if implemented right
and not morphed into something,and picked apart and criticized,
and all that, if implementedcorrectly, it will change the
way care is delivered across thestate and I would submit to you
that if we can do it in thethird largest state in the
country, we can do it across thecountry.
Speaker 3 (45:43):
I agree.
Yeah, I agree.
You know, I'll be sending younotes on that one.
Speaker 4 (45:47):
You can, you can.
I'll keep you updated.
Speaker 3 (45:50):
I'm just as excited about that as you are, except
I'm not on the committee.
So if you could leave a legacyon health care, in health care,
right, if you could leave alegacy, I mean I think you still
have a couple decades left.
Speaker 4 (46:04):
I have some time.
Speaker 3 (46:07):
Yeah, I mean I think you still have a couple of
decades left.
I have some time.
Yeah, I've got a long roadahead of me, but what would that
look like for you?
What would feel like the rightthing to leave?
Speaker 4 (46:14):
It's a great question actually.
You know when it's my time, letme just set the context.
So, as a leader, I believesomething, a very simple concept
, that the true testament of anyleader anywhere, any industry
anywhere, but in this case,healthcare when you're ready to
leave, retire, move to the nextgeneration gig, whatever you're
(46:38):
doing, and you can look back andyou can say you know what.
I left the place that I wasresponsible for better than when
I found it and now I'm passingthe mantle.
You've done your job as aleader, because leadership isn't
about kingdom building andcontrol as much as people do
that stupid stuff.
It's not about that.
It's not about your ego, and weall have ego invested in it,
(47:01):
and when people say, well, Idon't have my ego invested in it
.
Speaker 3 (47:04):
Oh, I know I just listened to a podcast episode
with John Mackey.
With you know, he's the founderof Whole Foods and it was
really interesting to hear hissort of self-actualized versus
ego, and I totally agree withyou.
Speaker 4 (47:25):
Right, so they're full of you know people are full
of BS when they say well,there's no ego invested in me,
and we all have a little bit ofego invested in what we do.
But that should not be how youmeasure your success, right?
It should be.
Am I leaving the place that I'mresponsible for better than
when I found it?
And when I pass that mantleonto the next generation of
leader, I'm passing a mantle tohim or her that's better,
(47:48):
stronger, more resilient.
So my legacy is I want to leavean aspect of it.
I want to leave a system and Iplan on staying where I am until
I am done, until I retire,because I'm very committed to
what we're doing at TGH and atUSF or, in a broader sense,
florida Health Sciences Center,in relationship to what we're
(48:12):
doing across the state.
I want to leave a system thatis driving world-class quality
clinical outcomes and safetyworld-class quality clinical
outcomes and safety.
That's highly reliable, meaningthat there's very little
variability in our performance,that it's sustained.
So, regardless of who you are,where you enter, you're getting
(48:33):
the same care at the same levelwith the same outcomes, and
those outcomes are world-class.
And I want to do it at a lowercost and I want to be able to
say that not only are weproducing these great levels of
quality, but we're also doing itless expensively.
Oh and, by the way, we'vepassed that value on.
Speaker 3 (48:55):
Right, not just more profitably.
Speaker 4 (48:58):
We've passed that value on to the consumer, to the
patient, to the employer, toeven the payer.
Now we have to make money.
Payers have to make money.
In my case, I'm a big private,not-for-profit academic health
system.
I can't provide care and can'tfulfill my shared purpose if I
(49:19):
have a padlock on my front doorbecause I can't run profitably.
So you've got to make money,yeah Right, but there's plenty
of money in the system.
My thesis is plenty of money inthe system.
It's how we use the money thatneeds to change.
Speaker 3 (49:36):
Listen, you know that you and I disagree a little bit
about the lifestyle diseasething.
Right, we spend trillions on it.
Trillions of that healthcaredollar that should come out is
on lifestyle disease.
We don't need to have type 2diabetics running around with
kidney failure.
Speaker 4 (49:51):
No, no, I agree with you.
Speaker 3 (49:53):
But to me that's where there's cost to take out
of the system.
There's a way to do this better, right.
Speaker 4 (50:04):
Just because you hit something, there's costs to take
out of the system and there's away to do this better, and my
hypothesis is that way is carecoordination.
Speaker 3 (50:15):
Agreed, I agree.
Speaker 4 (50:16):
Right Like creating for the consumer.
Speaker 3 (50:20):
Well, think about it, john right.
People don't know how toreverse lifestyle disease.
Speaker 4 (50:25):
Right, no, no, no, listen, we do differ a bit on
that, but I believe that healthand wellness and lifestyle
issues are a part of carecoordination.
It's just not the centerpieceof who we are.
Speaker 3 (50:37):
No, because you're an acute care health system right,
and so I actually agree withyou because I think we need a
parallel healthcare system and Ithink there's plenty of money
to go around for that.
To your point, we havetrillions that we invest in
healthcare and so if there's asystem that people can access,
(50:57):
where they can learn how toreverse their lifestyle disease
and not just treat it like, hey,I right, there's plenty of
people that want to just keepeating kfc and, and you know,
drinking soda and like that'stheir personal responsibility
with this who doesn't like thehamburger or k from mcdonald's
or kfc?
Speaker 4 (51:16):
I love it.
Speaker 3 (51:17):
We're getting ready to record a hot ones, so so so
I'll throw listen tamp, throwlisten Tampa general.
Speaker 4 (51:23):
My, my academic medical center has a McDonald's
in it.
People will say I can't believeyou have McDonald's.
My attitude is well, wait aminute, you're an adult, right?
Yeah, so you're telling me thatyou don't have enough
self-control to choose whetheryou want to go to McDonald's or
not, so I have to take it awayfrom you.
(51:44):
I don't believe in that.
If you don't want to eatMcDonald's, don't eat McDonald's
.
I know I might say thoughyou're going to love this, ellen
McDonald's has plenty ofhealthy choices on the menu.
If you don't want a Big Mac ora Whopper, you can choose
healthier options.
Speaker 3 (52:02):
Healthier Right, okay , there's a difference between
healthy and healthier.
Speaker 4 (52:06):
You can get a salad.
Speaker 3 (52:07):
That salad isn't nutritionally dense, though you
can get a salad at McDonald's,and if you're in New England
like us.
Can you get some lobster?
Speaker 4 (52:16):
You can get a lobster roll in the summertime.
Remember growing up as a kidthat was a summertime favorite
at McDonald's Real lobster in abeautiful bun, toasted,
delicious.
Speaker 1 (52:26):
I love it.
I know, I know you can get alobster roll at TGH is what I
think Justin's wondering hewants a shrimp?
Speaker 2 (52:34):
There should be some Gulf Shrimp, yeah.
Speaker 4 (52:37):
You find a lobster roll yeah.
Speaker 3 (52:40):
And you said it right , I am not one of those, that's.
The other thing is, I don'tthink idealism is going to get
us anywhere.
Right Is being an idealist inall this and trying to be a
purist.
It's not going to get us toyour point.
We have to convene, and so mything is like hey, two things.
If we're going to have aMcDonald's, then let's have a
(53:01):
bolet.
Like let's just have something.
So if I'm stuck in the hospitalI can get something healthy.
Speaker 4 (53:07):
Let's make it taste good, you know what I'm saying,
right.
Speaker 3 (53:09):
But the other it's having multiple choices.
But the other thing is, youknow, having some way for people
that when they're ready, whenthey're ready to make a good
choice, they have a way tofigure it out.
And that's where I thinkhealthcare really does a
disservice.
Speaker 2 (53:21):
You know, if she was admitted to the hospital, she
would be at the farm trying topick her own vegetables.
Speaker 4 (53:28):
Well, we some for another time, but I'd love to
have you as my guest and I'llgive you the personal tour of
our garden.
We have a huge community garden.
Food pharmacy, primary careattached to the food pharmacy
and huge community garden.
I've heard about that.
I'm very excited about thisFood pharmacy Yep, Primary care
attached to the food pharmacyand the community garden.
We do yoga, tai chi, we have aneducational pavilion, we have a
(53:50):
sizable farm and we have a foodpharmacy and a food pantry for
people.
So you come into our primarycare office and type 2 diabetic
and the doctor says you know,you're really only a type 2
diabetic because of your diet.
I'm going to give you a 12-weekprescription to our food
pharmacy and you're not onlygoing to be able to get food for
free, vegetables and all thegood stuff but we're going to
teach you.
(54:10):
We're going to teach you how tomake it and how to process it
Exactly.
Yeah, we do do that.
Speaker 3 (54:14):
We do See the beauty is is that, to your point, in
the way the system set up today,you're going to have a padlock
on your front door if you go allin on that at this moment 100.
I mean, that's the bottom lineright, however, there is.
You are at risk well, right, butno, no, and I'm not asking you
to become a payer but if youwent to pat garrity and said,
(54:35):
all right, I got 100 people thatI know are your people and they
want to come to my communitygarden and go to my primary care
position, get healthy, and myhealthcare delivery is going to
do that for you and I want apiece of the pie when I do it,
that's different than youbecoming a payer?
Speaker 4 (54:52):
No, no, I totally agree.
So I I look at if Pat wassitting right here and he is a
wonderful and, like I saidearlier, his organization is
great.
And we don't always agree, Imean, we definitely fuss at each
other, but we are completely inalignment.
You're absolutely right.
When people say to me are yougoing to become a payer?
You're going to go to it.
No, no, no, no.
Speaker 3 (55:11):
Not in my lifetime, right, and I'm not saying you
should, no but do I want topartner with payers?
Speaker 4 (55:17):
Do I want to collaborate with them?
Do I wish I had that kind ofrelationship with United and
Aetna that I do with the Blues,Absolutely I wish I had that so
do all of our clients I don't.
I have a very, very goodrelationship with Florida Blue
and it will remain very strong.
But yeah, you're right, I don'tbelieve, like a lot of health
(55:38):
systems and they do it for theirreasons and their reasons are
their reasons Not a lot ofhealth systems, and they do it
for their reasons and theirreasons are their reasons.
I I not a criticism of it, butI don't understand.
When a health system wants tobecome a payer, I don't get it.
We don't actually care forpatients appropriately.
Why would we get in?
well, that's a whole notherbusiness when we can't even do
the core business the way itneeds to be done?
(56:00):
Let's go master that.
Speaker 3 (56:02):
Right or figure out a combo.
Speaker 2 (56:03):
Well, there's a lot of me too-ism going on where you
hear stuff and like, oh geez,they're successful.
Why don't we have our ownhealth plan?
Speaker 3 (56:08):
That's a great point, I flew around the country
helping people start Medicare.
Advantage plans because youknow they went to some
leadership institute meeting andeverybody talked about it and
then everybody needed to havetheir health plan.
Speaker 4 (56:17):
You know how hard it is to run one of those things.
It is really hard we havethat's.
Speaker 3 (56:22):
John that has been the core of our business for
many years, is like helping.
And, to your point, the systemis not set up for those models
of care to succeed and do wellin that, and it's a.
It's a, so you have.
And culturally it's misalignedso you have to realign
culturally to be like.
Speaker 4 (56:42):
So anyways, we could like I know we've got, you know
we got to move on, but you knowwhat it brings us back to this
conversation.
Care coordination no it brings,it brings us, you bring.
If we should have that drinking, you know like if you?
Speaker 3 (56:55):
ever watch us, if you hear this word take this word
take a drink.
Speaker 4 (57:05):
It should be care coordination over my head, no,
but you know not that we'recondoning over drinking because
we're not.
We're not.
It's a healthcare podcast.
Right, we are not Drinkresponsibly.
But what it brings us back tois the concept of where the
federal government could play areally significant and
thoughtful role.
How about being a convener?
How about bringing all theelements and the parts and
pieces of the industry togetherto sit down and to really
(57:25):
collaborate and rebuild andretool a system?
Now, what my critics will sayis you're being completely naive
and you don't understand theindustry the way we think you
should.
I totally disagree.
I know this industry betterthan most and absolutely as good
(57:46):
as some.
Right, I mean I, I, I know theindustry, not perfect at it by
any stretch, which you'll findout on Monday, but with each
decade.
Speaker 3 (57:58):
you've got better.
With each decade I'm gettingbetter.
It's like wine, but truthfully,I've gotten better With each
decade.
I'm getting better.
You're getting close toperfection.
Speaker 4 (58:03):
It's like wine, but truthfully, I mean, people would
say, john, you're being naiveand you don't quite understand
how complex this is.
No, I know exactly how complexit is and I'm not being naive.
What I'm asking people to do isthink differently.
It's sort of like the reversemullet Think differently, behave
differently, not for the sakeof it, but the country is
(58:25):
depending on it.
If you don't have a healthy andwell society, you don't have a
strong country, you don't have astrong economy, you don't have
anything.
And I think there's anopportunity where you get payers
and providers and all differentaspects of the industry in a
room with venture capital,private equity, entrepreneurs,
(58:47):
real innovators, and you sitdown and say what does a system
look like in a free market,capitalistic society?
Speaker 3 (58:56):
What does it look like that meets people where
they are?
Speaker 4 (58:59):
That meets people where they are and that is
sustainable, exactly Right, andthat's reproducible and that's
highly reliable.
The answer is there, it's noquestion about it.
The lens that we're lookingthrough to see the industry
needs to change.
Speaker 3 (59:16):
So I have to come up, so you have to help me before
the 18th of September, so wehave a very quick time frame
here.
I am now dating this podcast,right?
Yeah, that's all right.
But I will be up at a Hill Dayand it's all about innovation
and I need to have an elevatorpitch on what we just talked
(59:39):
about today.
I have to like re-listen tothis elevator pitch on what we
just talked about today.
I have to like re-listen tothis because that's what I will
say.
At a bipartisan level, there isa desire societally to impact
this.
A hundred percent, and sothere's a lot of momentum in
different places.
But I really appreciate thatpoint around convening.
That's what we're missing.
Speaker 2 (59:59):
Your words helped paint a picture in this white
space behind me of what thingscould look like.
Speaker 1 (01:00:04):
So it's very inspiring.
The thing is and I'm bringingus in for a landing because we
need to, I know, because we have, because we could talk.
Speaker 2 (01:00:09):
It wasn't my fault that we didn't land the plane
yet.
Speaker 1 (01:00:12):
It wasn't my fault no , we usually well, we usually
close with this question thatyou essentially just answered
right, which is you have a bythe world, a coca moment, or
when pigs fly?
I think you're convening Idon't want to put words in your
mouth, but I think you answeredthat question when pigs fly buy
the world a coca I don't knowJohn looks like he's got to
finish.
Speaker 4 (01:00:30):
No, I think you're right, but I think it's very
doable, and you said something,ellen, that's important.
It's not a partisan issue, it'snot.
It should not be politicized.
The health and wellness of thepeople of this country should
not be politicized.
Speaker 2 (01:00:47):
Whether you're a.
Speaker 4 (01:00:47):
Democrat, republican, an independent or however you
identify.
When it comes to the health andwellness of the people that we
are responsible for in thisgreat nation, we should be
coming together andcollaborating and innovating and
building a new model, and notfor the sake of building a new
model, but because we need tobuild a new model, because we
(01:01:11):
are on a unsustainabletrajectory with healthcare costs
and quality.
And for the real cynicalistthing, the budget can't be
balanced unless you deal withthe Centers for Medicare and
Medicaid federally.
Yeah Right, it can't be no, andso we have to think differently
.
Speaker 3 (01:01:29):
Well, the trust fund is going to go.
I mean the trust fund is goingto be bankrupt.
Speaker 4 (01:01:33):
And my biggest fear is, somebody will come in and do
it for us if we don't do itourselves.
Speaker 3 (01:01:37):
Oh, you're 100% right .
Speaker 4 (01:01:38):
And we will not like what they do to us, we will not
like it.
I don't know what it would be.
I could venture to guess, butwe're not going to like it.
So right now is our time.
It's not 10 years from now,it's now, and so we got to get
after it.
So what is my when pigs fly,kind of thing, but I do think
this is achievable is whenyou're up in the hill.
(01:02:00):
It's how do you build somethingand how do you build a process
and a collaborative?
We're like-minded.
People from different parts ofthe industry come together to
build the new model ofhealthcare.
Speaker 1 (01:02:17):
Carter will love this so it's a, so it's a by the
world the Coke a moment.
Speaker 3 (01:02:21):
More so than pigs fly .
Speaker 1 (01:02:23):
Pigs will probably never fly.
Yeah, they probably will neverfly.
Speaker 3 (01:02:26):
Pigs flew a couple weeks ago, when they did in the
Simpsons too.
Well they also flew a coupleweeks ago when Epic announced
that people were going to beable to get their own health
data into apps as they wanted.
So there are pig flying moments, but anyways all right.
Speaker 1 (01:02:42):
Thank you so much for being here.
Thanks again, John.
Thanks for having me.
This is super fun.
I know it's rough on a Fridayafternoon.
Speaker 4 (01:02:47):
No, no, it's been great, thank you.
Speaker 2 (01:02:48):
We appreciate it.
Thanks again.
Speaker 3 (01:02:51):
Well, I'm Ellen Brown .
Speaker 2 (01:02:52):
I'm Justin.
Speaker 1 (01:02:53):
Politi and I'm Dave Pavlik.
We are the partners at.
As you can tell, we can talkabout this stuff all day.
Drop us a line.
We might even go down rabbitholes that are not at all listed
.
Speaker 3 (01:03:05):
Yes, exactly, but we are your best chance for real
change.
Speaker 1 (01:03:08):
We are your best chance for real change.
Speaker 2 (01:03:12):
Check us out at ep2healthcom.
Thank you.
Speaker 4 (01:03:13):
You guys are great you.
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