RamaOnHealthcare August 31, 2023
Beyond the Walls of Healthcare Today (Part Two of Two)
RamaOnHealthcare talks with Dr. Zeev Neuwirth. He is a healthcare executive with 15 years of experience in clinical practice and another 15 years in process improvement, clinical operations, population health, & care redesign. He most recently served as the Chief of Care Transformation at Atrium Health (now a part of Advocate Health). We discuss his recently released book, Beyond The Walls – Megatrends, Movements & Market Disruptors Transforming American Healthcare that has achieved Amazon’s Top New Release in Health Care Delivery and Hospital Administration. His previous book is, Reframing Healthcare: A Roadmap for Creating Disruptive Change .
Part Two. This interview discusses Humanistic Movements, Improved Approach to Senior Care, Strategic Domains, and Disruptors in Healthcare. Part One covers Optimism in Healthcare, Massive Potential of Platforms, and The Biggest Challenges. The first part of this interview can be found at “Q&A Part 1 of 2: Dr. Zeev Neuwirth, a Healthcare Executive“.
RamaOnHealthcare (ROH): In Beyond the Walls, you devote a third of the book – to humanistic movements in healthcare. What do you mean by humanistic movements? What would change for us as patients, caregivers, and family members if healthcare were humanized?
Zeev Neuwirth (ZN): The entire book is in service of humanizing healthcare. In Part 2, I call it out more explicitly and name a few of the movements humanizing healthcare. What I mean by ‘humanizing’ is that these initiatives all attempt to operationalize customization, contextualization, and personalization of healthcare – making it more respectful, dignified, and equitable. These movements are helping to shift care from the generic, one-size-fits-all, ‘rule-of-thumb’ healthcare to a ‘rule-of-one’ healthcare.
Chapter 4 illustrates the senior care movement, which recognizes our generic approach to care is grossly inadequate for the specific needs of seniors, especially those with multiple chronic and complex conditions. The book provides viable, real-life examples of markedly improved, customized approaches to senior care. Chapter 5 introduces the contextual care movement and illustrates how one organization, Laguna Health, embeds evidence-based contextual factors into a state-of-the-art, AI-enabled care management platform. Chapter 6 discusses the whole-person, whole-healthcare movement and shares an example of how this new paradigm of care is being deployed in one of the largest healthcare systems in the country, the Veterans Health Administration.
…our generic approach to care is grossly inadequate for the specific needs of seniors….
What would change for patients, caregivers, and family members if these humanistic movements were widely adopted? First, the healthcare experience would be customized and more relevant to our specific challenges and needs. Care would be expanded to include a focus on wellness and well-being. Patients’ sense of purpose and meaning, as well as their intrinsic motivation and priorities would be embedded and valued in the healthcare process. As a result, care outcomes, especially in chronic disease, would be significantly improved. We would experience significant reductions in ED visits, hospital admissions and readmissions, and decreases in mortality and morbidity. The costs of care – both at the population and individual level – would decrease. Taking a lesson from the VHA’s Whole Health initiative, one fundamental change would be a widening the aperture so that the core healthcare question would include, “What matters to you?” and not just, “What’s the matter with you?”
ROH: How might a “beyond-the-walls” healthcare approach address the rapidly growing needs of aging patients?
ZN: Our healthcare system is not structured to care for Seniors – particularly those with multiple chronic and complex conditions. It’s not organized or resourced to address the complex and unique clinical and psychosocial issues that Seniors encounter. I have spent the past few years interviewing the professionals and non-professionals who daily take care of aging parents, grandparents, and relatives. When you dive into it, it’s almost unconscionable that a country as wealthy as ours, with a healthcare system as advanced as ours, does not appropriately attend to its elderly and infirm population.
Also, keep in mind that there are over 60 million Americans over the age of 65. Seniors are the fastest-growing demographic in the US. By 2030, they will make up one-fifth of the American population, and by 2050, there will be well over 80 million Americans over the age of 65.
What do we need to do? We need to develop segmented, customized clinics and services, as well as non-clinical services and products specifically geared toward the unique and varied needs of the aging and infirm.
A Beyond-the-Walls approach for Seniors would include:
- Adopting and expanding Senior care models like ChenMed, Iora Health, Devoted Health, Patina, Humana’s CenterWell, and Optum’s Landmark.
- Adopting and scaling contextualized care and support services such as Laguna Health, Lena Health, Papa, Together by Renee, Avanlee, and numerous others.
- Reforming and modernizing specialized services, including services for highly prevalent conditions such as cognitive decline and dementia.
- Adopting and scaling home-based care programs such as Medically Home, Best Buy’s Current Health, Dispatch Health, and Biofourmis – and the payment models required.
- Accelerating the shift into value-based payment models such as Medicare Advantage.
- Compensating providers for value-based care and outcomes – not piecemeal, fee-for-service payment which incentivizes unnecessary overutilization and disincentivizes preventive, whole-person care.
- Appropriately compensating geriatricians and others who provide additional expertise in caring for older adults. Geriatrics is among the few medical specialties where providers earn substantially less than general primary care physicians.
- Surrounding geriatricians, primary care providers and others who care for seniors with a multidisciplinary team and network of specialized resources.
- Creating payment and support for the 53 million non-professional caregivers in the United States who spend countless hours caring for their elderly, infirm, and disabled relatives.
- Embedding the social determinants of health, contextualized care, and a whole-health approach into clinical workflows and automated care algorithms.
Unless we get beyond the walls of a generic, one-size-fits-all healthcare system – a healthcare system that does not differentiate between a 35 and an 85-year-old – we will all suffer the consequences.
ROH: What other insights will readers gain from your book, Beyond The Walls?
ZN: This book outlines three strategic domains that are essential if we are to transform American healthcare. These include:
- The digital health & virtual care revolution that shifts care outside of centralized facilities to the point of need – enabling care to be much more continuous, connected, and proactive.
- The humanistic movements address disparities in care and focus on the customization and contextualization of care, and whole-person, whole-health care.
- Systemic market ecosystem changes bring unprecedented, titanic shifts in the market, including the platform revolution and the adoption and acceleration of novel collaborations and partnerships.
We have been existing in what I would call ‘the dark ages’ of healthcare delivery. I have experienced this first-hand as a physician, healthcare executive, patient, and family member of patients. Our systems, approaches, and concepts significantly limit healthcare delivery outcomes and experience. These are significant problems that adversely impact most Americans. We desperately need our leaders to understand and address this dire situation – and address it in new and different ways. We need the courage and conviction to collectively steer the industry in a more humanistic direction.
We desperately need our leaders to understand and address this dire situation – and address it in new and different ways.
Despite the current realities, I believe we have the opportunity to create a healthcare renaissance. But it will not happen on its own. It will require leaders to be aware of the moment we’re in, be mindful of what is required to get us out of the bind we’re in, and catalyzed to take courageous, positive, transformative action. Our collective efforts over the next few years will determine whether we remain in the dark ages of American healthcare delivery and continue an unsustainable and potentially catastrophic course or emerge into an era of enlightenment.
…we have the opportunity to create a healthcare renaissance.
As I state in the book’s epilogue, “It takes visionary leadership to see beyond the walls, but it takes courageous leadership to travel beyond them.” The book provides a humanistic vision, a critical strategy, and concrete examples of what we should be doing more of. What our times call for are mission-driven leaders to accept the challenge and create a ‘beyond the walls’ movement. My mission is to get this book and its message into those leaders’ hands, hearts, and heads.
‘It takes visionary leadership to see beyond the walls, but it takes courageous leadership to travel beyond them.’
ROH: In the last chapter of your book, you mention how the disrupted (legacy hospital systems) can become disruptors. What do you think hospital-based systems can and should be doing?
ZN: In the book’s final chapter, I outline what the legacy healthcare systems, primarily hospitals and large provider groups, can do to shift from being disrupted to becoming the disruptors; or, more to the point, the advancers. Hospital-based systems have what I’ve termed “Superpowers and Secret Sauces.” In short, the Superpowers are Presence, People, & Platforms, and the Secret Sauces are Consolidation, Collaboration, and Care Model Transformation. This chapter explains each one of the superpowers and secret sauces and illustrates them with real-life examples.
…the Superpowers are Presence, People, & Platforms, and the Secret Sauces are Consolidation, Collaboration, and Care Model Transformation.
Vertical partnerships and novel collaborations are a key theme throughout the book’s final section. Another key theme is a focus on trusting relationships. I will be shocked if executives and board members read the final section of Beyond The Walls and don’t come away with new ideas they can implement. At a minimum, it will give hospital system leaders and their collaborators a new sense of the possibilities and opportunities. If legacy systems don’t begin to leverage their superpowers and secret sauces fully, others will. Hospital system leaders must shift their thinking and actions beyond the walls to thrive in this next era of American healthcare.
Vertical partnerships and novel collaborations are a key theme…. Hospital system leaders must shift their thinking and actions beyond the walls to thrive in this next era of American healthcare.
About Dr. Neuwirth
His previous book, Reframing Healthcare: A Roadmap for Creating Disruptive Change (2017), achieved #1 status on Amazon for Hospital & Health Policy. His podcast, Creating a New Healthcare, has 150+ episodes to date. He is an alum of Tufts University and the University of Pennsylvania School of Medicine with a Master’s in Healthcare Management from the Harvard School of Public Health. He lectures at Harvard and Yale Schools of Public Health. Find more here: