Show cover of The Healthcare Leadership Experience

The Healthcare Leadership Experience

Healthcare management is ever-changing.  Join Lisa Miller and Jim Cagliostro where you will hear from innovators and leaders within healthcare and from other industries. Lisa and Jim will bring you topics on the business and clinical sides of healthcare on strategy, finance, managed care contracting, nurse engagement, physician engagement, new patient care models, patient satisfaction, innovation, leadership, communication, marketing, plus much more.   This show will challenge you to think differently through proven strategies and innovative approaches that will help you to elevate your healthcare management and healthcare leadership performance for the ultimate goal of providing exceptional patient care.   Enjoy diverse and thought-provoking conversations. Lisa and Jim will present best practices, new strategies, and ideas for you to think about and to implement in your career and your healthcare organization. To contact Lisa Miller, please email: and on linkedin at . To contact Jim Cagliastro, please email: and on linkedin at   This show is sponsored by VIE Healthcare Consulting;


Why Your Old Healthcare Marketing Strategy Isn’t Working| E. 111
Marketing effectiveness has fallen by nearly a quarter since 2020. Ian Baer, Founder & Chief Soothsayer at Sooth, offers his insights on how healthcare organizations can respond, with Jim Cagliostro.   Episode Introduction Ian shares how 90% of today’s marketing decisions are emotional, and 80% are made on impulse, and the challenges of ‘’marketing by the pound.’’ He also explains why a regulatory environment means healthcare often stays in the shallow end of the marketing pool, how data unlocks empathy between brands and audiences, and advises everyone to ‘’bring your soul to work every day.’’   Show Topics   Making emotional connections in marketing Sooth helps brands to understand the truth Healthcare has unique marketing challenges ‘’Marketing by the pound’’ The roadmap of healthcare marketing is the most complicated The power of patient stories Leadership tip: Bring your soul to work every day     08:13 Making emotional connections in marketing  Ian said 90% of the decisions people make when spending money are emotional.  ‘’AI, it's very buzzwordy, but what it does for us is it allows me to take what used to require one or two years of custom research that might cost hundreds of thousands of dollars, into a methodology that we can execute in a few weeks to give a brand a very clear understanding of the emotional journey of the individual that they're trying to reach. Now of course, the impact in healthcare is huge because look, 90% of all the decisions people make when it comes to spending their money are emotional. It's a big mistake marketers made for decades upon decades in thinking there's a balance between the rational and their emotional. No, there isn't. People make emotional decisions, and then they seek rationale to back up where their heart has already gone. And Harvard did some brilliant work that they published in 2016, an article I recommend to anybody and everybody get their hands on, called The New Science of Customer Emotion. .. And what they found was, of the thousands of different emotions we all experience, it's been estimated that people experience 34,000 different emotions. … But what they found is there are actually only 10 things that we feel as humans that have a positive correlation to the way we spend our money.’’   14:54 Sooth helps brands to understand the truth  Ian explained the background to his company name, and its purpose.   ‘’So, I went looking through my LinkedIn profile, just going through all my experience and, "How can I describe what I do?" And I found a LinkedIn recommendation from a former client in which he referred to me as, "Soothsayer." And it reminded me that very often, when we were at a time of crisis for his brand, he would pick up the phone and call me and say, "Oh, soothsayer." And that would very often start our conversations. I thought, "Well, that's a really interesting word." I always thought a soothsayer was somebody who predicts the future. It's not. Soothsayer is somebody who tells the truth. The word sooth literally means truth. It just went obsolete in the English language about 400 years ago when Shakespeare got done with it, which is what enabled me to actually trademark it as the name of a business. It's pretty hard to get a vernacular word as the name of your company. So, when we decided to name the business Sooth, because in reality that is exactly what we're doing is helping brands understand the truth, then it just followed suit that I should be the soothsayer, that we actually have two practices at the company. We have the soothsaying practice, which is determining what the truths are, and then our client partnership practice, we call those people ‘’soothsolvers’’ because what they do is actually take the truth and put it to work in really smart marketing recommendations, and work in partnership with senior leaders on the client side.’’   17:23 Healthcare has unique marketing challenges Ian said the regulatory environment means that healthcare is averse to taking marketing risks.  ‘’Because of the regulatory environment, healthcare marketers have learned to play it extremely safe, and it's understandable. The last thing you want is a slap on the wrist, or much worse, from the FDA when you've spent countless millions of dollars, let's say, bringing a drug to market. But the result is most healthcare marketers have become conditioned to stay in the very shallow end of the swimming pool. And where that becomes unfortunate, we spoke earlier about no industry really needing empathy in their marketing more than healthcare. Well, we now have the ability through use of data, through use of technology, through one-to-one connection and interaction, through experience design, to create a really special personal experience. And yet, data privacy is a scary thing. Engaging with someone, one-on-one, whether it's through social media or other, that's a scary thing because you may wind up having to capture adverse reaction information that you then have to report to the FDA, that a lot of people would prefer not to get their hands up. So, the result is you have too many brands that don't say enough to really be helpful to people, and they're holding back way too much. And one of the biggest challenges there is the unregulated side of the healthcare space, the area that a lot of healthcare marketers might not want to acknowledge as legitimate, companies selling nutritional supplements, companies selling devices that don't really have any medical benefit, but they're claiming, "Just put this on your wrist. Just put this on your knee. Just sit up against this thing." They're not operating under the auspices of the FDA. They're making outrageous claims, and almost daring consumers and competitors to sue them. And because we live in a world now, where it's very hard for anyone to find one truth in any area of marketing or the news, consumers are somewhat in the crosshairs here. So, if healthcare marketers play it too safe and continue to stay in the shallow end, the ones who lose are the very patients and families that they're trying to help, because they'll chase false promises that really are leading healthcare marketers can fulfill in a much more meaningful way.’’   21:35 ‘’Marketing by the pound’’ Ian said marketing effectiveness is down by nearly a quarter since 2020 and 80% of people make decisions on impulse.  ‘’Yeah, marketing effectiveness overall is down 23% since 2020, as a global practice, across all industries. Marketing is significantly less effective than it was 20 years ago. So, we have more data than ever, more technology than ever, more access to people than ever. And we're getting so bad at this that most brands have now shifted much more to managing the economics of marketing, how much they're spending. It's become somewhat of a marketing by the pound model because if we can't get it to produce more, then we just have to spend less on it. And everyone has gotten to settle for this reduced level of performance. How did we get here? Well, impulse is a huge issue. The extent to which people make purchase decisions, and a decision to seek out a certain medication, that falls into the category of purchase decisions. The extent to which people do this on impulse has doubled in the last 10 years, and the amount of money people spend on impulse purchases like that, "I'm going to click twice on this Facebook ad and get those gummies and throw out my metformin." That's happening faster than ever. So, when 90% of decisions are emotional, when 80% of people are making decisions on impulse, which means they're not gathering the facts, they're not gathering information, they're not calling their doctor, they're not asking other people who are suffering with the same condition. They're just saying, "Yep, that's for me." That's how we got here.   26:33 The roadmap of healthcare marketing is the most complicated Ian explained why patients and professionals walk one path, with multiple points of view at every step.  ‘’Here, every step of the way, there's an advisory relationship going on. There are certain things the consumer can do without the professional. There are certain things they cannot do without the profession, and it really is a pathway that needs to be curated. We need to understand where they come together and the information they need to reach the right decisions, and where they're going to be off on their own, exposed to different information. So, I think starting with the fact that there is no differentiated journey between the patient and the professional, but actually it's one journey, it's one path, and they're both walking it. They just enter and exit at different times. I think that's the most critical truth to understand, to start to do this thing the right way and to see every one of the decision points through multiple sets of eyes: the patient, the professional, often caregivers are involved. Sometimes you have primary and specialist professionals, institutions, payers. There are multiple points of view at every stage that need to be considered. It is the most complicated roadmap of marketing that exists.’’   30:32 The power of patient stories  Ian said there’s no substitute for hearing people’s ‘’data-rich’’ real stories.  ‘’There's a lot of things a drug company can't say, that a patient can. And I think the more drug companies get comfortable giving voice to the people who are actually on the journey with that disease or that illness, it's really going to help bridge the gap between this kind of odd mix of old school branding and clinical detail. But within all of that, I have a hard time finding the humanity, and I think the more brands get comfortable, letting people tell the story of what it's really like to experience the uncertainty of disease, the hope that comes with treatments. I had a heart attack six months ago, a massive heart attack, the type that has a 96% fatality rate. It was the first cardiac event of my life. It changed my perspective on everything. I've learned a lot about my body, about my health, about what it's going to take to live a good healthy life for as long as I can. I've got a story to tell. There's millions of people like me who have stories to tell, and I would love to see more healthcare marketers be brave enough to let people tell their own stories. I think that would make a dramatic difference. Through the work we do here, we try to approximate that. We do a very good job of creating data-rich stories that represent people's beliefs and fears and tendencies. There is no substitute for hearing people's real stories. And when I see healthcare brands step up and tell real stories, I applaud them…… People retain information 30 times more when they hear it in a story.’’   34:41 Leadership tip: Bring your soul to work every day  Ian shared an encounter with journalist Jimmy Breslin.  ‘’If you've never heard of Jimmy Breslin, you should find out who Jimmy Breslin was, because in New York in the 1970s and '80s, he was the most important voice in journalism. He told the stories of this city. And I got to meet him. And in a conversation in which he talked me out of a career in journalism, which is a story for another day, the advice he left me with was... the last thing he said as I walked out of the room, "Hey kid, don't be a suit. Whatever you do, don't be a suit." Now, nothing wrong with suits. I own a few. I wear them occasionally, but what it really meant to me and what I internalized and have carried as a mission is, "Don't ever give up who you are in the pursuit of business success. Don't ever give up your integrity. Don't ever give up your identity. Don't ever let a company tell you what you're really about as a human being." That has never let me down. It has defined both my good and bad career choices, but I think as much as you can stay true to yourself, that's what the world needs from you. AI is going to move in and automate a lot of the things that we don't need humans to do for themselves. So, more than ever, really bring your soul to work every day, and everyone that surrounds you will benefit from that.’’   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Ian Baer on LinkedIn    Check out VIE Healthcare and SpendMend    You’ll also hear:    Ian’s mission at Sooth: ‘’There's nothing more we can do as marketers, as a noble mission, than to help people live better, longer, healthier lives, protect families against the economic crisis that healthcare represents in our country right now. And that endless money pit, and homes and savings being lost, chasing solutions….. Our mission at Sooth is really all about being able to quantify and leverage a very deep level of understanding and empathy to solve people's problems. And gosh, doesn't healthcare need that?’’   Disease is the #1 cause of bankruptcy in the US: ‘’People don't talk about that enough. It is more than just selling drugs. So much more than that. When you talk to people whose lives are being impacted by these diseases, it changes everything.’’   What Soothsayer offers to healthcare organizations: ‘’What we do as a practice is give brands a highly robust understanding of all of that intricate emotional decision-making that they can literally wire their brand's marketing into. There is no category where empathy matters more than healthcare because everyone's journey with an illness is unique. …we're able to see all the way through, see where those emotions collide, see where they might cause people to sort of go into their own camps and how the brands can bring them back together.’’   Why brand equity is occupying the wrong place in the timeline: ‘’Most brands still are too focused on the moment of truth, whether that truth is a click, whether that truth is a purchase, whether it's making an appointment, whether it's a visit, whether it's an order, whether it's a script. And what they're not focusing on is understanding who that person is before those transactional moments take place, and solving their problems, or at least giving them a pathway to a solution before they ever reach the moment of impulse. Because once you let them get to that moment of impulse, it is Dodge City.’’   Data unlocks empathy: ‘’…my whole business is about using data to unlock empathy between brands and audiences. So, there's a huge role for data to play, but data is not just about targeting and segmentation and managing the numbers side of things. We are all, really, walking data vaults. Our data includes experiences, our data includes our emotions, our impulses. These are data points too, and they're every bit as valid and important, and drive 90% of the impact of marketing effectiveness.’’ What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.  
37:38 15/05/2024
The Growth of Patient-Centered Care | E. 110
US health systems are slowly adopting a patient-focused approach. Shanil Ebrahim, Partner in National Life Sciences & Healthcare Consulting Leader at Deloitte Canada, explains its benefits to Jim Cagliostro.    Episode Introduction Shanil explains why healthcare needs to move away from the ‘’one-size fits all’’ approach to patient care, why patients should be treated as partners, rather than recipients, and the impact of a healthcare model designed around systems. He also outlines why patient-centered care is an investment in quality and efficiency and highlights the benefits of adaptability in leadership.   Show Topics   Patient care goes beyond managing health conditions Healthcare is designed around the needs of the system  ‘’Patient feedback should shape everything we do’’ Funding the cost of change A champion for patient care Improving the patient experience leads to better outcomes Leadership tip: embracing adaptability      05:12 Patient care goes beyond managing health conditions   Shanil said patient-centered care is designed around patient preferences.  ‘’Ultimately, when you think about that term, at its core, patient-centered care is about ensuring that healthcare systems and all of their processes are fundamentally designed around the patient's needs or their experiences or their preferences I should say. And this approach goes beyond just treating diseases or managing health conditions. It's about considering patients as active participants in their own healthcare, which means that any sort of treatments or healthcare plans we develop, it's not about just focusing on clinical guidelines alone, but how do we deeply integrate that with the individual's lifestyle or their cultural background or their personal preferences into how those treatments are actually planned and executed?’’    10:45 Healthcare is designed around the needs of the system Shanil explained how the historical context of healthcare models affects patient care today.  ‘’…your question really gets at the heart of many challenges that we face in healthcare today, irrespective of where you are, whether you're in North America or globally, and you have to consider that historically, our healthcare models were designed more around the needs of the healthcare system than the needs of the patient. All you have to do is look at things like financial models of all of these health systems, which is focused on volume and paying for services that a doctor provides over value of the services or take healthcare organizations like hospitals where they prioritize operational efficiency, where you have a ton of metrics around that over personalized care. And even though we may make patient-centered care sound easy and obvious, transitioning to that type of care is a big paradigm shift when you consider that historical context. And it requires both a shift in mindset and operations.’’   11:48 ‘’Patient feedback should shape everything we do’’   Shanil explained why the starting point is to consider the patient perspective.  ‘’And to me, first and foremost, it starts with leadership commitments, whether your ministers or C-suite execs at hospitals to re-envision what healthcare should look like from a patient's perspective. And this means aligning the organizational culture with patient-centric values and training your workforce to adopt this approach in every interaction in every decision. And when you think about what are practical first steps that you can actually take, it often involves gathering extensive patient feedback to understand their experiences and needs better. Something that we talked about obviously just at a length. And this feedback that we get from these patients should shape everything we do from policy to bedside manner. And technology plays a pretty crucial role here because it can be leveraged to improve communication with patients. It can be leveraged to offer more personalized health management tools or provide healthcare professionals with real-time data that is much more patient-specific, so that they can continue iterating in terms of what they need to do on a daily basis.’’   16:19 Funding the cost of change  Shanil said the initial cost of transitioning to patient-centered care should be viewed as an investment in quality and efficiency.  ‘’Now in the US, where the healthcare system is more privatized, funding might come through insurance reimbursements or through investments by private health systems where they're looking to improve patient satisfaction and reduce long-term cost. You can't think about this as a short-term game, and you have to be able to measure what the value of the investment is now on something that hits long-term as well. And this is where whether your insurer or providers like hospitals, they could also tap into incentives offered by government programs or payers for meeting certain patient care standards and patient outcomes as well. So that's kind of giving you a contrast between those public health systems and the private healthcare systems, right? But regardless of the country, the initial cost of transitioning to patient-centered care needs to be viewed as investments. And these investments, by the way, Jim, are not just financial. They're investments in quality and efficiency, that over time lead to cost savings, right? Because you are reducing interventions over time, you're reducing hospital readmissions over time, and you're also improving the management of chronic conditions. So right now, if we're aligning with those value-based care models, which by the way is gaining a lot of traction worldwide, it provides that financial incentive to improve those patient outcomes and that naturally supports a care approach or a patient-centered care model.’’   19:15 A champion of patient care Shanil said the role of patient experience officer is increasing but change starts with the CEO.  ‘’The question is how do we enable patient experience to be at the heart of the organization, because that's what ultimately it is, right? And usually it is a step-wise approach. So the first thing that we end up trying to see is who's going to be the champion? And largely, we want it to be the CEO of the organization. If it really comes from the top and they have their strategic priorities and strategic comparatives centered around the patient, it sends a message to not only the C-suite, but across the organization as well. So that's where we usually like to see it's starting right from the top. Now as we start to see this penetrate or proliferate throughout the organization, it's an interim solution, which is where you would want someone who owns this as a mandate going forward once the CEO has actually set its goals and the role of the patient experience officer is increasing quite a bit, and especially in larger, more modern type of healthcare settings because it bridges a gap between clinical care and patient satisfaction and someone has a mandate to continuously challenge that. Like isn't it great if we end up seeing the type of conversations that is happening between the patient experience officer and the CFO, which may end up having different imperatives where the CFO is not only thinking about the long-term cost, but of course thinking about the short-term cost as well and focused on operational efficiency indicators, whereas the patient experience officer is thinking about the long-term value that we're providing as a healthcare system.’’   22:55 Improving the patient experience leads to better outcomes  Shanil said capturing and measuring the outcome data is the key focus.  ‘’In a value-based healthcare model, the focus is squarely on patient experience and outcomes. Because the fundamental principle behind this is that these factors directly correlate with the effectiveness of care. And in terms of reducing costs or the burden on the healthcare system, and a better patient experience often leads to higher levels of patient engagement, which is critical for the success or uptake or adoption of treatment plans and ultimately improves overall health outcomes, which is the end goal of whatever we're trying to do, right? So even in simpler words, when a person or a patient feels supported and valued, they're just much more likely to actually follow medical advice and maintain their health regimens. This kind of connecting on the diabetes example that I actually provided earlier as well. And when it comes to the measurement, you can measure these patient outcomes over time to see how effective it is, whether it's measuring recovery rates or complications or taking holistic approach and measuring quality of life, which there's a significant amount of instruments or questionnaires around it, and they all serve as indicators on how we're effectively doing this and how effectively this value-based system is actually operating. But to be able to do that, and this is also turning out to be a fundamental problem or enabler that we need to fix, is we need to be able to capture all of this, this outcome data and these experiences that patients are having, and then we need to measure that data and have some analytics to offer us insights into how we're doing.’’   26:32 Leadership tip: Embracing adaptability  Shanil explained why adaptability has helped him to stay ahead.  ‘’…this is not just from a personal standpoint, but I also think about it from my team and the entire ecosystem because we're moving from traditional models of healthcare and healthcare delivery to highly tech enabled healthcare, and that shift is going to continuously increase as well, right? And ultimately, when you think about that tech enabled world, it's not about new software or fancy tools, it's just about a whole different way of thinking about patient care, thinking about patient data differently, thinking about how we improve effectiveness differently. And adaptability, ultimately thinking about all of these types of changes and in these type of contexts, for me as a leader, it means leading my team through this transition, ensuring that they are not only trained in new technologies, but they're also mentally prepared to embrace these type of changes, which is different because now it involves shifting our mindset from this is how we've done it previously, to what's the best way to do this now. And one thing I love about adaptability is that there's a lot of these sub-characteristics that are inherent to it to enable you to think differently. Because adaptability means you have to keep an open mind. Adaptability means that you have to be willing to learn continuously. It means you have to be resilient; you have to show that you're not afraid to pivot when the situation calls for it. And this approach, or this principle or this guiding principle, we'll call it, has not only helped me personally stay ahead, but it has also ensured that I can help lead my teams to continue to deliver high quality solutions to our clients no matter what changes come our way. So that would be the number one thing that I would share with your audience.   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Shanil Ebrahim on LinkedIn    Check out VIE Healthcare and SpendMend    You’ll also hear:    Healthcare is about people; Shanil’s passion for improving patient care: ‘’….the reason I do this personally is because one, I'm really passionate about it and it really stems from personal and professional commitment to making healthcare better and more accessible, especially for underserved and vulnerable populations, which has been a common thread throughout my career in terms of serving those populations.’’    Moving away from the one-size-fits-all approach to patient care: ‘’… we need to involve patients more directly, ensuring that they have easy access to their health information. We have to support them through various channels that respect their time, that respect their preferences, respect their individual life circumstances. And it's all about moving from your classic one-size-fits-all approach to something that is more tailored, more holistic, and responds to the needs of the patient.’’   Creating a healthcare experience where patients are partners not just recipients: ‘’…if we truly want to do this right, we have to measure the true value from it because all the things that I'm saying are also hypotheses that are based off of research…..And the ROI should be that if we provide tailored approaches to patients, they'll be better managed. They will get to positive outcomes faster, which means incurring less costs in the long run and everyone should benefit.’’   Why patient-centered care means a focus on the patient journey: ‘’And any sort of position, whether you call it a patient experience officer or someone wearing the hat of a C-suite executive that champions a patient experience, they would be focused on the patient journey through the healthcare system and ensuring that we're empowering the patient's experience. And one of the main reasons for creating such a role is let's have someone who systematically addresses and improves all aspects of patient experience.’’   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.
30:14 08/05/2024
Healthcare Strategy with Cole Lyons | E. 109
Strategic planning is vital to successful healthcare management. President & Co-Founder of The American Healthcare Journal, Cole Lyons, explains his goal of fostering a community of education to Jim Cagliostro.    Episode Introduction Cole explains why transfer of knowledge is a key goal of the Journal, why healthcare strategy can be described as moving from checkers to chess and emphasizes the importance of thinking before you speak. He also explains the importance of competition in healthcare and identifies humility as an essential leadership trait.   Show Topics   Redefining healthcare strategy A strategic alternative for nonprofits  Breaking down silos in healthcare Join Cole’s community on LinkedIn Applying economic theories to healthcare strategy Leadership tip: why humility matters     05:36 Redefining healthcare strategy  Cole explained why thinking about the impact of your actions matters.  ‘’For me, it's kind of thinking before I speak. I think that's the best way that I've come up with how to explain it. In operations, day-to-day, things are quite hectic, especially at high volume clinics. And you have to make very quickly, fairly educated decisions based on standard operating procedures. But sometimes that doesn't always lead us down the best path. So part of that is creating standard operating procedures that allow you time to think about how it impacts things long-term. So, thinking before you speak for me means instead of just saying what I need to say in the moment, I think about what I say, how it will impact the person hearing it, how it'll impact my image. And if you apply that kind of thinking before acting approach to your actions in the operations space, it means taking a step back and looking at the competitive landscape in your industry, looking at the competitive landscape in your institution, different departments competing for funding, different departments competing for exposure, and looking at how even small actions in the operations world will impact that.’’   08:12 A strategic alternative for nonprofits Cole said the Journal aims to foster improvement and education in strategic thinking for nonprofit institutions.  ‘’… the problem right now is VC-backed healthcare firms, those that are backed by venture capital. They have a high concentration of MBAs who have really good strategic insights. So don't get me wrong, and we can always go into this anytime, but there's a problem with a lot of the strategy theories out there in general that are taught to MBA graduates because it's based on economic theories that don't always play out in the real world. But still when they make decisions, it is much more strategic than in nonprofit healthcare. And so, one of the issues is that I'm not a fan of government-run healthcare, which is a little contrarian. I'm just not particularly a fan of it. I think that free market healthcare is good, nonprofit institutions are my favorite. I love nonprofit institutions. I think that that's the best form of delivering healthcare. But they don't act very strategically, especially compared to VC-backed or for-profit healthcare, which employ all these MBAs, they recruit MBAs from the top schools, they can pay them. …I'm not saying that they're any less educated, they're just educated differently. They have MHAs, they have MPAs, a lot of them have MDs, and they are educated in a very different way. So the journal's purpose is how can we foster this community of improvement and education in strategic thinking for these people who are educated in a much more practical way? An MHA isn’t sitting in their office thinking and going into philosophy a lot of times. A lot of times they're figuring out, how can we solve this problem? How can we deal with this emergency situation?’’   13:36 Breaking down silos in healthcare  Cole said administrative fellowships can help to develop a well-rounded approach. ‘’One of the ways that this is going to work out really well, and a lot of programs are doing this, is through administrative fellowships. I actually have a lot of different things that we're involved with with that, trying to get fellowship certified, trying to get fellowships publicized a lot because administrative fellowships have to rotate through every department in the organization usually. They know all the leaders. And so when they go and work in operations, they are very well-rounded. They have a much better strategic vision of the organization. They know clinicians, they know the house staff, they know the janitors, they know everybody. A lot of times they know the people who are on construction teams building the building. And so that gives them a huge, well-rounded approach that's also going to massively improve strategy. So yeah, the majority of organizations are still struggling. They're siloed or they don't even have really a strategy team, but there is a good trend for improvement I think on the way.’’   16:32 Join Cole’s community on LinkedIn Cole said anyone who wishes to get involved with the Journal can connect on LinkedIn and YouTube.  ‘’LinkedIn is one of the best knowledge communities. There's a bunch of knowledgeable people. All my mentors have come from LinkedIn. The past two jobs I've gotten, including the journal, so I guess my past three jobs, have all come from people I've met on LinkedIn. So I would say go to LinkedIn, the American Journal of Healthcare Strategy is on there. I am on there. Happy to network and connect with anyone. Also, just happy to be kind of a funnel connecting you to other people. If you want to meet someone in the Philadelphia region, I know most of the senior leaders here at least casually, so I can always connect you to somebody if there's somebody you want to meet. So yeah, LinkedIn is definitely the best way until we get that website and mobile app up and running…. I know sales teams have told me that they've benefited a lot, our YouTube channel and our LinkedIn, a lot of time our LinkedIn will link to the YouTube channel.’’   19:08 Applying economic theories to healthcare strategy Cole said education is important to help hospitals adapt to strategy. ‘’I think the first reason that it's important is because if you're an MHA grad and you're interfacing with an MBA graduate or somebody who's a consultant, I guess classically trained in business, you need to understand the economic theories that they're going to be using and you also need to understand why they seem flawed. So when you go through a strategic plan and you utilize one of these theories, it could be like Blue Ocean or you utilize Porter's Five Forces, I like them, I think they're excellent, but they are flawed in some situations. And coming from operations, you'll identify, "Oh, there's something wrong with this," but you might not exactly know how to explain it. And it'll give you the language, it'll give you the techniques. You'll be able to construct these Five Forces plans, the Blue Ocean Plan. There's another one I can't remember off the top of my mind. But then it'll take you and say, "Okay, here's the problems with some of them. Here's how you can identify what the issues are, and here's how you can fix them as well." So, when a consultant comes in and gives you this awesome plan, it'll not have you throw plan in the trash. It'll have you say, "Oh, here's how I can adapt it to fit my organization."    21:55 Leadership tip: why humility matters Cole said humility enables leaders to make connections.  ‘’Humility is really, really important. I've been so privileged to sit with most of the CEOs of hospitals in the Philadelphia region. I think that the humility of some of them is really astounding and it leaves a lasting impact on me. I also think that those are usually the ones who are most respected, being down to earth and being humble, speaking with all the members of staff because you actually need to and want to and not just because it makes you look good…Also, the other lesson Six Sigma, the Gemba walk, the... Before you can become a manager in Japan, you have to go through all the departments…When these people rotate through these departments, I was talking to one the other day that she was in the parking lot looking at the road signs in the parking garage and working with the builders in the state to make sure that these parking lot road signs were constructed correctly. A few years later, she's going to be a hospital administrator, but that experience in the parking lot looking at the road signs, invaluable, because now she has a connection to the whole organization. And you can only make that connection if you're humble.’’   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Cole Lyons on LinkedIn    Check out VIE Healthcare and SpendMend    You’ll also hear:    Transfer of knowledge, the goal of the American Journal of Healthcare Strategy: ‘’It’s really essential that we think of things differently. …. what we're trying to figure out is how to transfer knowledge around in a better way, whether that is through consulting one-on-one, whether that's through one-on-one coaching, or whether that's through podcast or video. How can we get a community that is knowledgeable and is empowered by that knowledge? That's what our real goal is at the end of the day.‘’     From checkers to chess; another way of looking at healthcare strategy: ‘’So with checkers, you're kind of looking at the very next move. With chess, the best players are looking many moves ahead. And how one move in one side of the board will affect the move in the other side of the board. It's a pattern of thinking that's very hard to develop even. In the first way I mentioned with thinking before I speak, it's very challenging.’’   The role of competition in American healthcare: ‘’Even though we have problems with our population care, our actual procedures that we perform, there are lots of medical tourists coming from other countries to receive care in the United States because our healthcare is really excellent in terms of a lot of the quality. We want want these nonprofit firms to be able to compete really well against VC-backed. And so that's what motivates us.’’   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.  
26:09 24/04/2024
Ideas Worth Pursuing | E. 108
Tech startups are predicted to disrupt US healthcare in 2024. Scott Nelson, co-founder, and CEO of venture backed FastWave Medical, offers his strategies for success in innovation with Jim Cagliostro.    Episode Introduction  Scott reveals the two signs that an idea has potential, why market trumps everything in innovation, and why leaders should focus on eliminating pain points for their end users. He also advises innovators to connect with potential strategic acquirers at an early stage and explains why leaders of startups shouldn’t put all their eggs in the venture capital basket.   Show Topics   Two signs of a good idea  Market ultimately trumps everything in innovation Engage with potential strategic acquirers at an early stage Finding investment in your community  Flipping the script: eliminating pain points Effective ways to raise capital Leaders of startups don’t have to be the CEO  05:49 Two signs of a good idea  Scott said there are two things for leaders to consider in innovation.  ‘’I guess to answer your question in a little bit more long-winded way, I would say if you've got an idea that you can't seem to shake a little bit… It's sticky and you find yourself maybe waking up at night thinking about it or you thought about it and then two weeks ago you're still thinking about it, maybe a month goes on, you're still thinking about it, that's usually a good signal. Maybe there's something there, but the most important point from my perspective is before you go too far, before you get too latched onto this idea, you really need to think about two things primarily. One, does it solve a real glaring problem? Is it a painkiller? I remember interviewing Dan Hawkins way back in the day. He was actually the founder of Shockwave, the company I mentioned previously, was very early at Intuitive Surgical, was the founder of Avail Medsystems, et cetera, serial entrepreneur. And he phrased, this was back in, I think 2016 or 17, but he mentioned finding a painkiller, not aspirin, not Tylenol, but a real painkiller, something that really causes a lot of pain, whether that's from a cost perspective, whether that's from a workflow perspective, but something that's like, there's a lot of friction there. That's what your idea hopefully solves for, a real painkiller. And then secondarily, if you think you're onto something that solves that real pain point, secondarily, you need to think about this as early in the process as possible. Who's going to pay for it?’’   09:03 Market ultimately trumps everything in innovation  Scott explained why market is the #1 factor for potential entrepreneurs.  ‘’I sort of fundamentally believe that market ultimately trumps everything else, right? Now, don't get me wrong, you could have a great product and a great team, but if it doesn't serve a huge market, you're going to have to think about other ways to fund that, right? Maybe it's a product that you can invest your own money in. Maybe it's a product that you can get to market quite quickly and use revenue and profits to support the company's growth, etc. But the reality is you need a big market to serve in order to give you optionality to capitalize and fund your idea or fund the company moving forward. So I do kind of think market trumps everything, because again, you could be working on a great product, have an awesome team, but if the market just doesn't support it, it's likely not going to have a lot of substance there. On the flip side, you could have an awesome market and maybe a decent product and a decent team, but it's probably going to do fairly well because the market supports that need. So, long story short, there's a couple of different ways to think about it. They're all important. ‘’   12:38 Engage with potential strategic acquirers at an early stage ‘’Obviously you need to be careful and cognizant about not disclosing too much, but the imperative is really to start engaging early on with those, what you perceive as potential strategic acquirers, really under the guise of just an introduction. You're not trying to sell them anything. It's a dating process. You're trying to get to know them, inform them of what you're building, what you're working on, so at least have a high-level idea. And as you continue to make progress against your idea and against your milestones, keep them informed. Not just them, but hopefully potential investors, people that... stakeholders within your community. You want to be communicating the progress that you're making against the idea or the product that you're building. So I can come full circle on your question. I just think it's really sometimes underappreciated, and it's actually a tip that I picked up on from Duke Rohlen, he's the founder of Ajax Health, serial entrepreneurs, had multiple exits under his belt, but he mentioned this, in an interview maybe close to 10 years ago now that I had with him. That was one of the things that he really focused on with some of his early wins is really an evaluation of all of the players in a certain market and what are they missing? What are the gaps in their existing portfolios? And he put together a matrix, and that helped think about how his product could potentially fit into the portfolios and where it fits with the broader space, if you will. And so that I think is sometimes maybe a little bit underappreciated from most founders and CEOs that are highly focused on their idea.’’   14:38 Finding investment in your community.  Scott said your community could be the source of potential investment.  ‘’Generally speaking… you want to engage with your community as early as possible. In your community could be your end users of your product. Your community could be the payers. Your community could be investors. Your community could be those likely potential strategic acquirers. You need to be engaging with them early, having a lot of conversations early under the guise that you want to let them know who you are, what you're building, what you're working on, and you want to keep them informed on your progress, right? Because if you can demonstrate over the course of six, 12, 18, 24 months that you delivered on what you said you were going to do, that's probably the most impressive thing that you do. You could present a fancy pitch deck, you could have an awesome advisory board. Your product could actually be quite cool, but the thing that's going to stand out is your ability to execute against the things that you say you're going to execute against. That's the most impressive thing. That's always going to stand out to strategic acquirers, investors, even your end user stakeholders. So I really, really think it's important.’’   18:41 Flipping the script: eliminating pain points Scott said the key question to ask yourself is how your idea makes life easier for your end users.  ‘’I think oftentimes we might want to flip the script a little bit and not necessarily think about our idea, our technology, offering so many more benefits and so many more improvements. Actually, what does it eliminate from the workflow? What pain points, what friction does it take away from my end users to make their life more simple, more easy to use? And hopefully through that process, we're delivering on those cost savings, right? Because so many times, especially in MedTech, and rightfully so in some scenarios, we think about how to get a pricing bump, or a pricing increase. In reality, your business model might be just delivering a slightly better product, but at a very attractive price. A Costco model. So that's not a bad play. And if your wheelhouse is really more around maybe cogs optimization or supply chain management, and that's what you really know well, there could be some great ideas in there where you can just simply deliver a good enough product, maybe slightly better, but just at a very attractive price. And that could be a phenomenal idea. And so I think those are a couple of things that I would think about under the guise of how do I differentiate myself versus competition? Don't think about your product doing so many great things. Think about how it can remove friction in a process and make your end users' lives more simple, more easy, less stressful. And then maybe just as important, how can it remove costs from the equation?’’   22:30 Effective ways to raise capital Scott said innovators need to be thinking in terms of major milestones about fundraising.  ‘’ I'll probably say fairly high level, but I really would encourage everyone to think about how they're raising capital. Think about it in cycles, if you will. You want to raise enough capital, ideally, not too much per se, but not too little either. But raise enough capital where you can achieve the next major milestone in say, 12 months. And you need to make that very, very clear to all your potential investors, this is what we're raising our money for. This is the next major milestone that we're targeting. So being very, very clear about that and kind of thinking about your fundraising and tranches, if you will, like that. And again, it is really very important. Yes, you want to be in a position where you don't run out of cash for sure, but you also don't want to take so much money upfront that you get so diluted that will impact future fundraisers. So yes, think about these near-term milestones. Those are crucial, but also think about how those may impact the next fundraise as well. So I definitely want to, I'd like to start out there because I think it's a point worth emphasizing for anyone that's working on early stage technology.’’   26:03 Leaders of startups don’t have to be the CEO  ‘’I think as leaders of startups, you don't necessarily have to be the CEO. If you're in some sort of leadership capacity within an early stage company, I would just keep in mind that when you're trying to direct your team and push the ball forward, but you're pushing in essence a boulder uphill with a lot of friction, momentum is crucial. So as a leader, you need to keep that in mind, is do everything within your power to keep the momentum going forward. There's always going to be trade-offs as your company evolves, but ensuring and optimizing for momentum, that's so, so crucial. So that's probably one of the things that probably stands out most as part of this broader startup idea.’’   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Scott Nelson on LinkedIn    Check out VIE Healthcare and SpendMend    You’ll also hear:    Three things for every innovator to consider: ‘’As your idea begins to evolve and begins to take shape, you need to be thinking about…what product am I building? What market does it serve? And who's the best team to effectively build this?’’ One key piece of advice for startups: ‘’As a startup, if you're working on an idea, the most likely scenario for a potential liquidity event is an exit to a strategic acquirer.’’ The blurred line between payers and providers: ‘’Once my technology is approved or cleared by the regulatory body and I'm ready to sell, then I need to think about who's going to pay for it. Well, the reality is … the lines between payers and providers, is really, quite blurred… They ought to know who you are and what you've been building for hopefully months, if not maybe a couple of years.’’ Don't put your eggs all in the traditional VC basket: ‘’If you're so highly dependent upon traditional VCs, likely they're going to get squeezed…. So the onus on founders, CEOs, in terms of fundraising is to keep a lot of options on the table, go far and wide. It's a lot of work.’’   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.
28:00 17/04/2024
Managing Purchased Services Contracts | E. 107
Purchased services is often the most overlooked expense in healthcare yet offers opportunities for cost savings. Brian Bartel shares his best practices for effective contract management, with Jim Cagliostro.    Episode Introduction  Brian explains the unique challenges of purchased services, why a centralized contract repository is the first step to successful purchased services management, and why hospitals should never allow contracts to auto-renew. He also explains why ‘’red flags’’ aren’t always necessarily malicious and why it’s vital to question the line-item details of your purchased services invoices.    Show Topics   Purchased services present a unique challenge in healthcare #1 tip: Create a centralized contract repository Review your contracts on a minimum annual basis Don’t assume all red flags are malicious The hidden cost savings in your line-item details Be inquisitive, be patient, be strategic – and build relationships 06:35 Purchased services present a unique challenge in healthcare Brian explained the difference between supplies and purchased services.  ‘’…When you're talking about supplies, it's pretty easy. You've got a specific item number, you've got your power set, your requisitions, everything is very orderly. So things are coming in, you can track it, you've got the data behind it, there's a contract with that line item pricing. And then when you get confirmations back, usually people are using some form of EDI, which makes it relatively easy, and you can track that. Item A is item A, item B is item B. Purchased services is different because it typically is not on a PO. Again, I've worked places where it is, but that comes with its own challenges. It's very department specific, so you've got usually a department manager or leader that's kind of running that point with it. We don't have as much interaction on the supply chain side of this either. Communication is usually kind of sparse between supply chain and a purchased service provider as compared to a typical supply vendor. And again, the data is just, it's more difficult. When you start looking at how things are being invoiced because there's no PO line, it gets very challenging to try to figure out, "Okay, what's actually happening with this spend?" Typically, an invoice will come in, the department manager signs off on it, it gets paid, and that's it. So a lot of opportunity there.’’   08:30 #1 tip: Create a centralized contract repository  Brian said a centralized contract repository was the essential first step to successful purchased services management.  ‘’I think that at square one, I think the biggest thing you can do is if your organization or your hospital, your ASC, your clinic, whatever it is, if you don't have a centralized contract repository, that's step one. Again, stepping into certain roles in my past, you've got contracts that might be down in admin. You've got department managers that have signature execution authority and they've got them in their files, and then you realize three years later that there's been this contract that nobody's really paying attention to because it's just a paper copy. Really I think that that's the biggest thing for me is getting your hands around it. Number one, you've just got to have that centralized repository. Again, that doesn't mean that you need to use software. Software obviously makes things easier. I'm a big proponent of that. But again, even just saying, "All right, nobody can sign contracts except for," whether it be your CEO, your CFO. "Send all these down and we're going to put them in a file cabinet." At least then you can go and try to find where those contractual documents are.’’   10:07 Review your contracts on a minimum annual basis Brian said it’s important not to let contracts auto-renew.  ‘’It’s always good to have that check-in annually, even if it’s just pulling the contract, making sure when does this contract terminate? That’s the other thing about automated systems through contract software is that you can set those flags. “Hey, something’s coming up 180 days later.” Again, with things that are just auto-renewing, that’s an issue too. If you miss that window to terminate something that you do want to go out to bid for, or maybe it’s a contract that you don’t need anymore. And I’ve seen, you’ve probably seen it too, 180 day out clause, some of these things. So if you miss that, that’s going to be a problem. As far as reviewing, it depends too on the type of service. Some of them are much more important, and so having a quarterly business review or a semiannual business review is important, and that gives the vendor time to come and showcase what it is that they’re doing too, because at the end of the day, sometimes these people are coming in, they’re doing great work, but nobody really knows except for that department or specific area that they’re there too. So giving that face time opportunity for the vendor, especially on those critical contracts, is important as well.’’   12:21 Don’t assume all red flags are malicious Brian said reaching out to the vendor is important if you notice an invoice discrepancy.  ‘’I think that that's where you've got to have a little finesse, again, realizing that some of these contracts, there's a lot of relationships built in. Again, if you've got somebody that's on site providing this, odds are they built those relationships. So I always take the approach when I notice that something's not going well on my side, if I notice an invoice discrepancy or something, it's an automatic red flag, but don't assume that it's malicious, right? So the first thing that I recommend is definitely reaching out to the vendor, the supplier, the individual, whoever it is that's your point of contact and just have that conversation. Say, "Hey, we noticed that there's a deficiency here," or, "We have a question about this invoice," and give them a chance. Because again, remember, on their side, I think it's probably maybe not quite as complex as it is on ours, but I know that just the conversations that I've had with suppliers in the past is that there are mistakes made when they're sending out invoices on a monthly basis or whatever it is. Again, give them that opportunity to rectify, at least bring it to their attention, and don't assume a malicious intent, even though that's probably from a supply chain standpoint, something that we might tend to do a little bit too much, right?’’   14:22 The hidden cost savings in your line-item details Brian said a detailed review of purchased services invoices can uncover significant cost savings opportunities.  ‘’At the end of the day, we're paying for whatever it is that we've signed up contractually for. And so having that actual invoice in front of you will tell you a lot of different things. Number one, you get the contract. Number two, you get the invoice. And then you start going through, does this make sense? Are things lining up? And I found some just very easy wins, things that they've been charging for, like an EVS vendor that was charging for restroom service, thousands of dollars a year, nobody knew what it was, and all they were doing is just bringing in little scent pads and not even going into the restrooms. But that was a line item that nobody had really questioned before. And so by seeing that actual invoice, again, now you're not just seeing it as X amount, now you can actually go in and see what it is that they're invoicing for. Again, correlating back to the supply chain side, we know that. We know each individual widget, case, box, each, but until you see that invoice a lot of times, if you're looking at it from a GL perspective or an expense, you don't see that line item necessarily all the way down to that detail. So it just tells you a lot. And again, maybe I'm just a nerd, but I like doing that. I like pulling those occasionally and just making sure, do the sniff test. Does this seem like everything that it should be? And then ask those questions. And again, you learn through that too. Some of the services that we have, it's like, "Oh, I didn't know that that was included." So again, that goes back to the communication with the vendor or supplier, give them opportunity to explain what it is that they're invoicing as well.’’   19:05 Be inquisitive, be patient, be strategic - and build relationships  Brian said building relationships is vital in leadership.  ‘’I think the biggest thing is just like I mentioned before, be inquisitive, have patience, and be strategic. A lot of the things that we would like to get done, whether it's supply chain or in our personal lives, it takes a while. So build those relationships, know what you want to do and know that it will take time. Rome wasn't built in a day. And so when you have those opportunities come up, if you're strategic about it, that door opens a little bit, you've got all your ducks in a row, then you can walk through and say, "Hey, I've got a solution to try to fix this, because I've been working on it in the background." So I wish that there was more that I could say than that, but I know personally that's what it is. Be inquisitive, be patient, be strategic, and build those relationships. Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Brian Bartel on LinkedIn    Check out VIE Healthcare and SpendMend    You’ll also hear:    From critical care to materials management, Brian’s journey in healthcare: ‘’No day is the same. Hopefully we can bring efficiencies and streamline processes to avoid some of these chaotic fires that pop up, but again, every day brings this new challenge.’’   A straightforward definition of purchased services: ‘’I just keep it simple. Is it a service that we're purchasing and that's usually typically some sort of a purchase or a contract or an outsource of some service that we're taking advantage of.’’   The benefits of a mentor in effective contract management: ‘’If you would've just stuck me in purchased services when I left the critical care access hospital, I would've had no idea, but I had a mentor, I had somebody that was teaching me that. So rely on those people and ask those questions. Ask the department managers, your GPO. Again, I know that there are pros and cons of GPOs, but that's a great place to look too.’’   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.  
21:11 10/04/2024
Supplier Relationship Management | E. 106
Flourishing supplier relationships can transform healthcare organizations. Samer Haddad, shares his experience of building and navigating successful partnerships with Jim Cagliostro.    Episode Introduction  Samer explains why trust is the foundation of all successful supplier relationships, the importance of human-to-human connection and why a partnership sometimes means giving your partner the benefit of the doubt. He also outlines the key to a successful exit strategy (plan, plan, and plan) and why solid leadership means treating others as you want to be treated, and leaving your ego at the door.   Show Topics   Supplier relationship management isn’t just a keyword  Trust is the foundation of successful relationships  Managing multiple suppliers is about more than spend ‘’Partnership is a partnership’’ Managing a successful exit strategy  Leadership tip: keeping your ego out of the way 04:33 Supplier relationship management isn’t just a keyword  Samer explained how the impact of Covid revealed the importance of strong supplier relationships.  ‘’When the world went into COVID and all the crises that came after that, in terms of shortages and everything, I can make a pretty easy judgment that there was a big differentiator between companies who made it and who maybe struggled mainly was supplier relationship management. Because when the real challenge came to the world, companies that invested in relations, companies that had deepened their relationships, especially with the significant suppliers to their production or to their delivery, whatever that is, made a difference. Those were the ones who were able to actually leverage that challenge to their benefit in the market. So they gained market share. The ones who had superficial relations, maybe more towards purely commercial kind of dealings, I think they struggled because, at such a moment, that kind of... I can't call it a human-to-human relation, or personal relation is where things are tested, and when companies need to make decisions, that's always an element. The trust between those organizations is essentially trust between humans that are doing business for years together. So if you just... we learn from the past two to three years it is I think many of my peers in procurement supply chain will vouch to the importance of supplier relationship management in general and not just like a keyword that you use and throw around…’’   07:09 Trust is the foundation of successful relationships Samer said KPIs can help to measure progress and build trust.  ‘’It takes time to build up that trust. So it is very important when we start a relationship that we create the proper agreement because this is why contracts are there. Contracts manage the relationship between parties. And you're establishing basically a baby kind of relation that has no trust yet, and you need to monitor it and start putting in the building blocks of that relation. Usually, in my opinion, that is established by having mutual mechanisms to judging how companies are engaging with each other. That could be the KPIs that you set. And it's not fair only to set a KPI for the supplier that you're establishing a relationship with, especially if you're looking long-term. Some KPIs should be set, maybe not in the contract, not necessarily, but self-imposed as you manage that important relationship that you know about. So you can even monitor internally how you're engaging with that supplier. Now, if you do that kind of fundamental layer of developing that relationship and you start building upon it, with time, trust starts getting improved and starts growing. It's like a baby, and it grows. It becomes an entity.’’   10:24 Managing multiple suppliers is about more than spend Samer said organizations need to understand how suppliers can impact their business.  ‘’…... But let's say what are the top 10 suppliers that basically can make or break your business? Because each business needs to know these kinds of suppliers. What are the suppliers that, if they don't deliver, you're going to have challenges actually delivering to your customer, or it'll affect your quality, or it might basically put you in a different pricing position in the market, which could basically hurt your business? So you need to understand those really well. And what I see as a common mistake is people treat category management as just a function, just an area. Like supplier relationship management. "Oh, you're a procurement person, so you do the procurement, invoicing, all of that. And by the way, you need to just take care of categories. Also, take care of the supplier relationship." It doesn't work. So especially when it's big business, when there's lots of money being moved around, you need people to focus on those suppliers and those categories. So I would recommend that you really understand the suppliers that drive the goals of your business and, at the same time, the suppliers that probably could hurt you if you don't nurture them. And that has nothing to do with spend, by the way.’’   14:41 ‘’Partnership is a partnership’’ Samer said treating suppliers as partners can help to navigate challenges during the contract period.  ‘’You can't go purely by contract. If I have a relationship with a significant supplier and they're misperforming, I can't just jump in and I basically come in with the request that, "You're not meeting the contractual agreement, and we need to go to remedies." That will destroy the whole thing. Partnership is a partnership. When you have a partner, you need to work with the partner. So yes, at some points, you might have to make hard decisions for the business, and yes, your top priority should be your business goals and your business targets. Nevertheless, I would say, depending on the situation, there's no one answer I can say here, but depending on the situation, you need always to give the benefit of the doubt for the partner. If they need help or support, you need to pitch in and help if you can. You need to offer that. You need to understand what's happening because it's easy always to blame the other party for the issues and challenges. You might be either contributing. If not, at some times, you get surprised, and you're causing some of that kind of challenge. So you need to deal with it as a partnership. So you look at the people, so the people you know, call them up or you meet them, you have a conversation around the challenge, you try to understand it, analyze it, break it down, go down a route where you're looking at a structured, logical approach to that problem. You're not there to blame. You're not there still to go for a contract. You're there to solve a problem with them as a partner.’’   17:26 Managing a successful exit strategy.  Samer said it’s essential to have a Plan B before exiting a contract. ‘’…. I assume someone who reached a point where they want to break up a relationship with a supplier, probably, we're talking about here, hypothetically, someone with a deep relations, one of those significant suppliers that affect your business, you need to have your own plan B. And this takes us to the first point I covered. I assume also that you did your job in creating contract that has a clear pathway to exit that relationship. If you have that, okay, so at least you have your map to exit that relationship, but also, you need to get things sorted before you go there. And the point comes where if you ask me, why would you do that? What's the tipping point that could take my company or me personally managing that department or procurement, in general, to go from point A, we have relationship, I need to break it. Well, it's a plethora of things. So it could be simply the attitude of the team on the supplier side that I'm dealing with. Once I see that there's zero care to the business I'm bringing, because sometimes they could grow as a company, my business is not growing at that rate. So I might become a much smaller piece of the pie for them. So things change, but the attitude towards my company is very important… there are red flags and red lines I think you should keep always, even with the best relationship, where you need to say, "I need to stop here, and I need to make a decision."    21:56 Leadership tip: Keeping your ego out of the way  Samer said knowing that your organization will succeed in your absence is the sign of an effective leader.   ‘’At the end of the day, a solid leader is the one who can have confidence saying, "If I leave today, work will not be affected." I think our ego gets in the way in many cases. I try not to let it affect me. It's a human thing. Everyone has it. I try always to make my decisions separate from fear. So I want my team to be able to generate leaders that could replace me at any moment. It's a hard mental thing to wire, but from my experience, it only pushes you towards growth in your career actually. It doesn't hurt you. It helps you a lot, and it gives you your life back because, today, when I go on leave, I do not look back because I know I have a solid organization, solid leaders in my team that if things go wrong while I'm away, they can take care of things. So treat people like you want to be treated and grow the next generation leaders in your organization.’’ Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Samer Haddad on LinkedIn    Check out VIE Healthcare and SpendMend      You’ll also hear:    Samer’s role within Emerson Automation Solutions and the push for sustainability: ‘’…now we're pushing more, especially in this region around sustainability, which again, gives you more reasons to enjoy what you do, and you feel that you are a little bit maybe contributing to that big change that's happening in the region and hopefully for future generations when it comes to the environment here.’’   Human-to-human connection is vital to successful partnerships: ‘’If you do the perfect KPIs and you always hit them, and you do the perfect contract, but you don't meet them, and you don't really engage with the supplier, members, and peers at that company, it'll never happen. So people, in my opinion, will establish you as a partner when you meet them, especially face-to-face.’’   Effective supplier management needs constant monitoring: ‘’Are we getting the best service? Are they satisfied? Do they have issues from our side? If there are issues from our side, are we addressing them on time? … And I think with that, you address 90% of the challenges and the problems.’’   The end of a relationship; deciding early and moving on: ‘’And do not hesitate .. because if you see really good reasons to exit a strategy, it's like maybe, I don't know if it's the right thing to do it, but it's like a divorce, right? Sometimes, if you spend too much time, it might hurt you and hurt your customers more. So, sometimes, it's just better to make a hard decision early and move things on, even if there are challenges. But make sure your business and your customers, first and foremost, are getting the service that they expect from your business.’’   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.
23:59 27/03/2024
Waste in the Hospital Supply Chain | E. 105
An estimated 40% of expenditure in the supply chain goes to waste. CEO Luká Yancopoulos explains to Jim Cagliostro how Grapevine Technology aims to put the power back into the hands of hospitals.   Episode Introduction  Luká explains how Grapevine can help hospitals save up to 80% on a single line item, how even small healthcare businesses spend six figure sums on the supply chain each year, and how to frame the reality of years of overspending to his clients. He also reveals three key ways that hospitals can lower the expense of their vendor management.      Show Topics   The power of building networks Supplies are a huge expense in healthcare Up to 80% of spend may be waste Connecting the source of supply to the end user Framing harsh truths on expenditure Seeing value every step of the way Leadership tip: deliver solutions to real problems 03:12 The power of building networks Luká said Grapevine can help its clients to save 70-80% on a single line item.  ‘’So Grapevine is working to make it very easy to basically manage your existing network. We've got healthcare businesses. They usually come to us, and they've worked with a handful of suppliers over the years. They think of each of these suppliers as their supplier for blank, fill in the blank, and Grapevine rewrites that. We think they're all your suppliers, they're all your network. Every time you add an item to cart from one of them, let's make sure it's the best price and that your other suppliers that you already trust and know don't have the same exact product at a cheaper price. Oftentimes, they do. We've basically redirected spend from one major distributor to another major distributor, saving the customer or the healthcare business 70%-80% on a single line item. The thing like a Becton Dickinson or a BD catheter or infusion pump or something they buy, and they have a bad habit of buying it from the wrong guy. So we basically let them link all their suppliers with the click of a button to a single screen, read in their current offerings, and tell them where to redirect their spend, acting as a traffic cop if needed.’’   05:14 Supplies are a huge expense in healthcare Luká explained that even small healthcare businesses are spending six figure sums on supplies every year.  ‘’Certain medical specialties get hit harder than others. If you're performing surgery, obviously, you're burning through a lot of supplies, you're using anesthesia, you're using all sorts of things that maybe your average urgent care clinic won't need. So we focus on specific specialties that have a high consumption rate of important and expensive technologies, things like oncology, dermatology, surgery, these sorts of things. Even a small healthcare business is spending six, seven figures on medical supplies and pharmaceuticals, like, a customer that comes to mind, a family-owned dermatology practice in upstate New York, and Rochester, New York is spending $200,000 a year pre-Grapevine on medical supplies. So like the instruments and whatnot, they're using sutures and implants and this and that, and then they're spending another million a year on injectables. Things like lidocaine, fillers, and different sorts of things of that realm.’’   08:38 Up to 80% of spend may be waste  Luká explained why a single supplier can’t offer hospitals the lowest price for every item.  ‘’I think that, in some cases, it's as much as 80% of the spend on supply is fruitless and extraneous. As far as what makes up those inefficiencies, there's a number of things. There's a classic idea that I am a strong believer of, that no one person or entity can be the best at everything. So even if you're comparing suppliers of the same business model, these large distributors, we could talk like McKesson, Henry Schein, Medline, the list goes on and on. Every one of those has built supply chains like warehouse fulfillment, shipping teams, customer service, et cetera, tailored around a specific core competency or level of products. So not one of those suppliers is going to be able to offer you the 5,000 SKUs or different item numbers that you need, all of the lowest price. That's naive. The way this world works is helping specialists, people that have specific skill sets, work together to serve a singular end goal.’’   10:24 Connecting the source of supply to the end user Luká said simplifying the supply chain is key to reducing costs.  ‘’I understand that when I'm buying it from a reseller, it needed to get in the hands of the reseller. That means it needed to get shipped there. That is a cost. Costs get built on the customer service, the labor. It all gets built into the price that hospitals are paying. By working with these downstream distribution companies that are, in some cases, 200 years old, you're just taking on additional costs. So if we can disintermediate supply chains when possible, connect source to end user as much as possible. You make things overall much more efficient. Then the third and really important major point, just to exemplify the inefficiencies and the lack of belief I have in these major distributors, is, you've got these distributors that people still buy everything they need from. These are the same companies that were selling cocaine pills to pregnant women in the late 1800s and arsenic pills for patient treatment and temperature up until the mid-1900s.’’   13:33 Framing harsh truths on expenditure Luká said understanding the extent of potential cost savings can be a shock to hospital executives.  ‘’People are definitely surprised, and honestly, I need to figure out a better way to frame sometimes exposing harsh truths to our customers because we've had people... When you find out that something bad's been going on for a long time and you're the victim of that bad thing, it does not feel good. We've got customers that are hurt by that. They don't blame us, but I wish we could deliver that more as an opportunity to win as opposed to an exposé of historic losses. I think you could do that with the right framing, with the right user interfaces, but it's something that we're not doing the best job of now, just packaging that and making it a digestible change for them. But yeah, people are shocked when they're working with, let's just say, even two distributors. They're working with... We've talked about the names already, so I won't name them here, but one 200-year-old company and they have another 100-year-old company that they've worked with, and when they add to cart for the first time on Grapevine that same IV catheter that they've purchased thousands of times, that they've spent literally millions of dollars on over the last couple of years, that one item number, and they add it to cart and it says, "But wait, you could buy the same exact item from the other supplier that you already trust and know for 70% cheaper." That happens. They feel a level of frustration, and rightfully so.’’    22:47 Seeing value every step of the way  Luká said that hospitals need to be able to see the win and the reason when they’re stepping out of their comfort zone.  ‘’So work with your existing suppliers, and you're going to save a lot of money by having them on one screen and us alerting you, and there's a cheaper alternative. Once you've done that, then, "Hey, why don't we introduce you to this broad network of new suppliers that we know, that we've vetted, that we trust?" And you can connect them and start subbing in not exact matches from your trusted network, but new suppliers or specialists that can add way more value, exponential value, and achieve even more savings. That's why we could deliver this all in month one as a 60%, 70% savings, but it's not palatable. People would rather get month one of halfway there, big win, see their wins and their hard work paying off, and see the value of what they're doing every step of the way. Every time we make them do something outside of their comfort zone, they need to be able to see the win and the reason. If it ties back to financial savings, that's part of it. For the people that actually shop, we're putting things into one screen, and that's a part of it. They don't need to flip between tabs and windows anymore. So showing what we do and showing why it's helpful to them every step along the way to mitigate the pain of adopting a new solution is a big part of our philosophy here.’’   25:19 Leadership tip: deliver real solutions for real problems  Luká said solving the biggest problems for your target customers is the way to unlock real value as a business.  ‘‘…So I think if you are following the white rabbit of real problems for real people, real struggles, and you constantly and iteratively try to come up with smarter and better solutions to solve those pain points, and once you do look for new problems, the next biggest problem they're facing, and continuously deliver real solutions based on those problems, I think that's the key to financial success as a business, is make yourself important, make yourself valuable, make yourself the solver of the biggest problems for your target customers, and that's the way that you unlock real value as a business and the money, the revenue, the whatever it comes all from that. If you're not important to solving someone's real problem, mending someone's real problems, then you shouldn't play the game of business in the world that we live in.’’ Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Luká Yancopoulos on LinkedIn    Check out VIE Healthcare and SpendMend    You’ll also hear:    How Grapevine is putting the power back in the hands of healthcare providers: ‘’We do that by showing doctors what they should be paying for the supplies that they use on a regular basis. We make it incredibly easy to achieve savings of more than 50% on their healthcare, medical supply, and even drug, pharmaceutical spend.’’   Helping healthcare organizations to shop smarter: The hospital that saved 40% in one month: ‘’We've got a public company that uses Grapevine. They have 80 locations. They're in the oncology space. They went from spending $400,000 a month on supplies down to $250,000 in their first month, which was January 2024. So they are down 40% in the first month. There's a lot more work for us to do there. I think we can get them down to close to 80%.’’ Recognizing that every hospital has unique needs: ‘’So yes, we need to have standardization. We need to have the best practice, best ways of doing things, but this hospital, this large health system in New York has different needs than a rural hospital out in Kansas or wherever it may be. So meeting those needs is going to look different. So we need to find ways to do that in order to minimize those inefficiencies.’’ Putting all of your data into one screen is the first step to reducing waste: ‘’If you're managing 100 different suppliers, and that means you have a person or maybe dozens of people or hundreds of people that log into one screen and then they are pulling up listings that look totally different, and then putting another window up and looking at it on the other screen and then trying to do that across 12, you're hopeless at that point. You need to have all of your options in one place. ‘’   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.  
27:27 13/03/2024
Using AI to Enhance the Hospital Supply Chain | E. 104
The US healthcare sector has struggled to put innovations like AI into practice. Mara Cairo explains the advantages of applying machine learning and AI for hospitals to Jim Cagliostro.   Episode Introduction  Mara explains why the first step towards successfully embracing AI is literacy, the challenges hospitals face in system integration and why AI isn’t intended to replace humanity in patient care. She also illustrates the benefits of AI for healthcare, including predicting patient no-shows, effectively managing inventory, and reducing costs, and explains why successful leadership means getting out of the way.    Show Topics   Taking the first step towards AI literacy The challenges of AI in healthcare Applying AI across industry sectors Anticipating patient no-shows The impact of AI on cost reduction initiatives Leadership tip: Hire the right people and get out of their way  03:48 Taking the first step towards AI literacy  Mara said AI literacy helps to overcome resistance to AI. ‘’Really the most important thing is AI literacy. It's just like learning what AI is, what it isn't, the types of problems it's really great at, the types of problems you shouldn't use it for. On the earlier side of the spectrum, we have lots of training and education really meant to get industry partners, but also the general public. We're working even with K-12 teachers and students now ... to make sure that everyone has that literacy because it's just becoming more and more important to kind of arm yourself with the information because we're being inundated with information and news articles and scary stories. So it starts with literacy, that's the first part, and then kind of evolves from there hopefully.’’   05:46 The challenges of AI in healthcare Mara said the complex needs of healthcare mean hospitals struggle with system integration.  ‘’There are different disciplines. Each maybe has their own labor agreements, regulation and whatnot. So when we think of human resources as a piece of inventory, that gets quite complicated quickly. Another thing, supply level. Inventory levels are complex. We kind of all saw it in COVID. The demand can spike really, really quickly. And you don't necessarily know when that's going to happen, right? So these surges can catch everyone off guard. And maybe traditionally it's been harder to anticipate when these surges might appear. Luckily, maybe machine learning is a tool that can help us with that. Also, just I think the shelf life of different supplies is unique to healthcare. You have to be really, really careful about storage and transportation requirements. And all of that is compounded by distance and transportation costs. Especially in Canada, in the far north, those care locations, they're really dependent on certain supplies, but if there's a road closure or a snowstorm or something, it's further complicated. The inventory supplies and healthcare are potentially life changing, right? So it's just so much more important that that is managed properly. And that complicates things. I think overall, in general, we've just seen that healthcare systems can struggle with system integration.’’   08:30 Applying AI across industry sectors Mara gave examples of how AI helps with demand forecasting and warehouse management.  ‘’Some of the really cool projects we've worked on with our industry partners in the supply chain space, but more in the kind of consumer goods area are things like demand forecasting. So helping them better predict what items they're going to need and when. What's really great again about working with our supply chain partners is they have a ton of data, historical data. And that's really, really important. When we start looking to build machine learning solutions, we often rely heavily on that historical data to be able to make those predictions about the future. So the demand forecasting problem is really ripe for innovation and for machine learning because usually there is a large amount of data and we can start making predictions based off of what's happened in the past about what supplies will be needed and when. Another cool thing we worked on with one of our warehousing companies was pick route optimization. So when you're picking items from an order, what's the most efficient way to pick the items to start fulfilling orders? And then to that even more so is how do you build your warehouse up from nothing? How do you make sure that the space is optimized the best way that it can be so that you're optimizing your pick route, but also so that maybe commonly used supplies aren't blocked in. So we're able to, again, use some really cool machine learning techniques and historical data to help just those ground level initial planning things to make sure that we're setting up these warehouses to be really, really efficient.’’   10:41 Anticipating patient ‘’no-shows’’  Mara said machine learning can help hospitals to predict individual patient no-shows.  ‘’And then maybe speaking more specifically about healthcare, one project we worked on was really cool. It was about managing staff inventory and patient load. So healthcare patient no-shows are a bit of a problem sometimes. My dad is a retired dentist, and that would just pain him every time there was a no-show. I know firsthand how frustrating that can be. And that can also lead to an oversupply of clinicians, right? It throws the whole system off. So we worked with one of our partners to develop a model that actually predicts the likelihood of the patient being a no-show. And if the model is saying, "This patient is likely to not show up," maybe we send them an additional notification. Maybe there's a bit of an overload of bookings in that anticipation that no shows are coming. So that is a really cool application of machine learning to hopefully alleviate a little bit of the load and the stress of the healthcare system.’’   14:27 The impact of AI on cost reduction initiatives Mara said AI can help to improve the flow of inventory from the outset and help with HR resource planning.  ‘’…machine learning can be really great with helping inventory management get closer to more accurate just in time delivery. So again, that sort of demand forecasting. I think currently the mitigation strategy for that is just to stockpile more supplies than you need, but then that leads to spoilage, especially if there's a shelf life and we're sort of back to square one. But machine learning is a really great tool for that demand forecasting, right? Also, these models can help us locate supplies where they're most likely required. So instead of last minute shuffling around supplies to an area that really needs them, which is increasing our costs, you're making sure that they're getting to the right care sites from the beginning so that it's just a more efficient flow of inventory from the very beginning. And then again, on the human resources side, even forecasting the future need for skilled professionals….if we just had a better line of sight into the future, which again, machine learning is a great tool to make those predictions, I see that as decreasing costs across the board and just making it easier to make decisions ahead of time, again, through data, but vetted by an expert that can also bring that domain expertise and that perspective to the solution too.’’   22:07 Leadership tip: Hire the right people and get out of their way  Mara also added that soft skills can be harder to teach in a technical environment.  ‘’I lead a team of very technical machine learning scientists. I don't necessarily have the exact same background that they do, but what I've found when I'm building my team, I'm really focused on hiring the right people, making sure from the beginning that you're investing the time and finding the right person and then sort of getting out of their way, but being there to support them if and when they need you. So I really want to make my team's jobs as easy as they can be and not have to worry about things that they shouldn't be worrying about. I think that's what I've learned through my leadership experience. And because I'm hiring often highly technical people, those roles can be hard to hire for. And I think, of course, technical skills are really, really important and valuable, but there's also a lot of room for growth. And when you're hiring early career professionals, they should be given the benefit of the doubt in some cases that they can continue to learn and grow in the role. So I am usually looking for those softer skills that are maybe a little bit harder to coach or teach someone. And because we're putting our young scientists right in front of a client like their first day basically, it's the softer skills that are much, much more important. I think when you're hiring technical people, it's really important to be aware of their understanding of the business side of things and if they're able to translate their fundamental technical knowledge into something that non-technical people can understand.’’   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Mara Cairo on LinkedIn    Check out VIE Healthcare and SpendMend      You’ll also hear:    AI is a journey:  ‘’It's not necessarily something that happens overnight, and we often refer to our AI adoption spectrum in a way to assess where our partners are at and where they want to go. …my team works with companies who are really ready to get some hands-on support to start building out these predictive models.’’   Overcoming the challenges of system integration in healthcare: ‘’…. Just… managing all of the information that's spread across different platforms, that can be really difficult to pull together and start understanding the bigger picture in real time. .. that understanding is really important and it leads us to solutions, but bringing all of that information together, …we've seen it being a bit of a challenging project to take on.’’   Maintaining the humanity in healthcare: ‘’We don't want a machine to be telling you that you have cancer, right? So whatever the solution is, we also want to make sure that there's a human in the loop maybe validating these decisions…..It's a tool for clinicians or anyone to use. And it's not meant to replace anyone. It's really meant to just kind of enhance our decision-making abilities with some ….data-driven insights.’’   How Aimii meets organizations where they are: ‘’…we have services where we work with our industry partners just to help them start brainstorming ideas. "So let's learn about your business. What are all of your problems? What data have you historically been collecting, and where can we maybe tie that data into the solution of some of these problems that we've kind of helped you brainstorm?" So that's just a way to help them start feeling comfortable that they know how to identify a machine learning solution to a problem.’’   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.
25:05 06/03/2024
Data and Research in Healthcare Analytics | E. 103
2024 has been described as a financial ‘’make or break’’ year in healthcare. SpendMend Research Supervisor Zachary Markham explains to Jim Cagliostro why time and data are money for hospitals.     Episode Introduction  Zach explains why the lack of timely, accurate data can delay recovery of credits, and why most hospitals only have 50% visibility into their spend and accounts payable processes. He also shares why duplicate payments and credit on spend are the top two methods for recovery of costs, and highlights how uncovering dark data saved SpendMend clients $413 million in 2023.   Show Topics   Data analysis identifies duplicate payments Timely data is vital to maximize cost savings The significant cost savings potential hidden in dark data 3 challenges to gathering hospital data Positivity and communication skills are essential in leadership     02:18 Data analysis identifies duplicate payments  Zach provided a ‘’birds eye view’’ of data analysis. ‘’So, when we initially get a client's data in, a hospital's data, we jump right on that data and we go ahead, we search account numbers and vendor contact information for each. So, if it's a larger healthcare system, we'll search for each entity within that healthcare system. We'll search for account numbers for all those, as well as the contact information for vendors. And then, for duplicate payments, that's a large revenue stream for us. So, that starts in the data scrub team. They scrub down the data and identify some good potential duplicate payments. And a duplicate payment is just an invoice that was paid twice for one reason or another. And once the data scrub team is done with that, they'll pass it off to us and we'll go into our client's imaging systems, where they store their invoices and we will pull those invoices and pass it back over to the data scrub team for validation. And I guess the third one here would be just various invoice pull requests for other departments, including the tax team, purchased services, as well as med device, just to name a few. And then, the last one I'll cover here just for the bird's eye view, PHIQ, which is protected health information. So, we've talked about data and it's extremely important to obviously protect our client's data, but it's equally, if not more important, to protect the patient's data as well.’’   05:24: Timely data is vital to maximize cost savings Zach said hospitals sometimes don’t obtain credits for years if price discrepancies aren’t found quickly.   ‘’I'll give you an example from my time as a pricing analyst. So, as a pricing analyst, we would review data price discrepancies that were about one to two years old from present from what they were currently paying, the hospitals were paying. So, we'd go through identify, "You're paying this vendor $20 for this item, when you should be paying $10 for that item," just as an example. And we would get that and working one to two years behind them. I guess the quicker that we would finish our review and then turn that back into the client, they'd be able to mend the price that they're paying, get it back to the contracted or agreed upon price. And also, collect the credits that were outstanding for the time that they were overpaying. So, I guess the sooner you can identify that you're paying at a higher rate than the contracted price for items, the sooner that you can correct it and get credits from the vendors.’’   07:44: The significant cost savings potential hidden in dark data Zach said hospitals only have 50% visibility into their spend and accounts payable processes.  ‘’Dark data is information that is hidden or not visible to a hospital for a variety of reasons. But it comes down to them not having the time, resources, or insights to uncover their own data blind spots. And I like to think of this kind of as a puzzle. So, when a hospital or healthcare system hands over their data to us, they're giving us basically a half put-together puzzle, and it's our job to put together the missing pieces or the other 50%. They only have approximately 50% visibility into their spend and accounts payables processes, and this dark data is essential to uncover, so our clients have a full set of data to make and implement decisions. And then what I always like to say is time and data are money. And then, as far as what hospitals can do about it... So, like I mentioned previously, hospitals are rarely equipped on their own to uncover their own dark data. Again, due to lack of time and resources. And that's where we step in as SpendMend to provide unique services that we do. All of our time and resources are used to uncover hospital's dark data through various tools and good old-fashioned investigating, I guess you could say. And in the past year alone, we've actually delivered $413 million back to our clients. ‘’   14:23 3 challenges to gathering hospital data  Zach said access to imaging systems, inadequate software, and losing data can all be obstacles to accurate data analysis.  ‘’Typically, when we get a new client, and again, this will be a rough number, we get probably 80% or so of those clients, we get imaging system access, which is vital to what we do. Then we're able to pull the documents that we need to support our claims. And not only that, but going back to the data, validate the data. That's imaging systems. And I'll break this down into three main categories. So, some healthcare systems or hospitals haven't invested in proper software to store their invoices or any. So, some hospitals don't have electronic imaging systems, so they're old school, storing their invoices on site within file cabinets. And that's tough for us to get to, unless we go on site. So, it's a lot less efficient that way…..And I guess number two there would be kind of the same category here. Some hospitals haven't invested in proper software to store their invoices. So, kind of like the first one, they use electronic folders within their system to store invoices, which in my experience with these sorts of clients, it's very difficult to locate invoices. And a lot of times it's not well-organized. It's timely to search for invoices, and a lot of them just straight up aren't uploaded, aren't imaged in these folders….And then, an issue that I've seen more recently regarding imaging systems, are hospitals upgrading their imaging systems and financial systems and leaving the old one behind. So, in essence, we're losing and they're losing the data that they've collected previously, and just starting fresh. ‘’   21:26 Positivity and communication skills are essential in leadership Zach said skillful listening is also vital to successful communication in leadership.    ‘’Well, I'm very blessed to be where I am within the company as the research supervisor. Anything that I accomplish or get praised for is not mine. It's God who gets the glory. He has blessed me tremendously through my life, but especially here at SpendMend in the past almost seven years. And then, I guess going over to the leadership advice, positivity is essential as well as communication, and then a subcategory of communication would be skillful listening.’’   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Zachary Markham on LinkedIn    Check out VIE Healthcare and SpendMend    You’ll also hear:    Zach’s career journey to Research Supervisor at SpendMend: ‘’I started with the company about seven years ago and I moved through a few different departments…. One being pricing analyst, another being a data scrub technician….. And learning the ins and outs of other departments within the company really set me up or at least paired with my education.’’ How SpendMend helps to identify and maximize cost savings using healthcare analytics: ‘’…. our healthcare systems are just …trying to stay basically afloat at this point.... They don't have the time, the money, the resources to really dig in like, all right, what did we do last week? What did we do a month ago? So, that's where we step in and help the clients along.’’ SpendMend cost savings directly impact the quality of patient care: ‘’’….. that's money directly pumped back into the American health system, which can be reinvested by or reutilized by the hospitals for nursing, if you want to bring on more nurses, staffing specialists, or robotics for surgeries, or whatnot. So, really, we're indirectly, directly affecting patient care and the quality of that patient care, which is what all this work really boils back down to.’’ The top two recovery methods for SpendMend clients: ‘’From my perspective, it would have to be duplicate payments and credits open on statements.‘’ What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.
23:18 28/02/2024
Workforce Development: Building the Next Generation | E. 102
US healthcare is facing a severe shortage of workers at every level. 6.5 million are expected to leave their jobs by 2026. Geoffrey Roche addresses the challenges in building a new workforce with Jim Cagliostro.    Episode Introduction  Geoffrey highlights the impact of the current staffing crisis in healthcare, and why leadership needs to evolve from a transactional to a heart-centered approach. He also explains why delays to access in care can cost hospitals up to $1 million every month, how one community college turned away over 13,600 qualified students from a program, and why every healthcare leader should become a mentor.   Show Topics   The impact of an ongoing workforce crisis A changing approach to healthcare leadership Industry and academia must connect to support the workforce Access to care delays may cost hospitals $1 million every month Delayed care leads to poorer patient outcomes and higher costs Qualified students can’t access vital healthcare programs All healthcare leaders should mentor     02:33 The impact of an ongoing workforce crisis   Geoffrey said the staffing shortage, combined with retention challenges, are impacting access to care.  ‘’… we sit at a huge inflection point. Probably without question the most challenging time in our nation's healthcare workforce is, as we speak today, certainly not that dissimilar from 2023. And when we look at it, we've got a significant supply and demand challenge. We know that there are not enough individuals graduating from college in pretty much every aspect of a healthcare program. We also know that retention still remains a very significant challenge, whether it's a clinical role or a nonclinical role. I think we have to be honest though about the impact that we are all seeing and will continue to face, particularly in the licensed areas of our healthcare system. It doesn't go a day where I talk to somebody and they share an access to care delay, whether it's in imaging, whether it's in lab, whether it's in outpatient or inpatient services. We're certainly at a very, very difficult time.’’   06:00 A changing approach to healthcare leadership Geoffrey said leaders in a multi-generational workforce need to demonstrate empathy and not judge.  ‘’I think leadership as a whole is taught very differently, right? And different points in time, different generations, the way that they have been taught leadership in some ways was command and control, which some would argue is more like transactional. And as we further see, we've got how many different generations, some people say five, some people say six. Whatever the number is, we've got more generations in the workforce than ever. And what we know is that our younger and our future generations have a much different view of leadership than previous ones. And we know that connection, respect, empathy, really this desire to understand that it's not going to just be the status quo, is not going to be the future of leadership when we look at all the different generations. And so it's really incredibly important that we have leaders in healthcare that can relate and understand and demonstrate empathy and not judge. I always say nobody should be judging on generations. I am the first to say I'm a millennial, but that doesn't mean right away go in and talk about, "Well, millennials leave jobs." That has no business in this conversation. What does have is how do we work together to achieve outcomes and results? And ultimately, I think if a leader can find connection with a person and help drive them, mentor them to achieve results, everyone's going to be rowing the oar in the right direction.’’   08:08 Industry and academia must connect to support the workforce Geoffrey explained why collaboration is vital to improve access to care delays.  ‘’….we have significant access to care delays in the healthcare system today where whether you're going for an imaging study, whether you're waiting to get an appointment for whatever it may be, cardiac related, oncology related, we have a really challenging situation where you have a situation where literally I talk to people across the country and they're like, "Well, I was supposed to get this study done, but the person who was going to do the study called out sick and they didn't have somebody else to do it." That's the reality that we sit in today, and we have to really address that. And that's really where that industry and academic connection comes in, where we've got to get strong connections where we're working together to make sure that not only do we have all the right programs to support the workforce, but that industry and academia are also coming together to talk to accrediting bodies, to talk to licensing boards because sometimes what's in place from a licensure end and from an accreditation end is not necessarily helping address these issues. We sit in a time of 2024 where some licensing standards and accreditation standards have been there for 40 or more years. Well, this is a very different world and a very different healthcare workforce today. And so I can't stress enough that importance that we really are fully integrated working as one towards the exact same outcome that we all want.’’   09:52 Access to care delays may cost hospitals $1m dollars every month  Geoffrey said high workforce costs need to be considered against the high cost in delayed access to care.  ‘’The other point I would just highlight is, look, access to care and access to education go hand in hand. But what we also know is that these access to care delays have a significant impact on the bottom line of the healthcare system. If you study it over time, whether it's an imaging study, whether it's other diagnostic related things, anytime you don't have the workforce to operate a specific piece of medical equipment, just on reimbursement alone, you could be looking at a million dollars a month. I mean, just think about that. When you think about that in the healthcare system, how much workforce costs. But then if you don't have the workforce to help operate the equipment that allows care to happen, they're not able to reimburse for it. And so there's a significant implication there as well. And so that's why these things are so important. First, people. But second, process and the impact and the financial is really critical.’’   11:42 Delayed care leads to poor patient outcomes and higher costs Geoffrey explained why costs will spiral if challenges in access to care are not resolved.  ‘’…... So access to care is delayed, ultimately they're probably going to end up in the emergency room. And then when you look at that situation, that care is going to be so much more costly than it could have been if that care wasn't necessarily delayed on the front end. While at the same time, we know workforce, people, still remain one of the top costs in our healthcare system for every single employer. And so most healthcare systems have tried to do their best to not have as many travel staffing occurring in all facets of the organization. And as part of that, obviously some have none today, many still do, but those costs are exorbitant. But the ultimate element is when patients can't get the access to care when they need it, that condition can get worse, diagnoses can be delayed, and it just can further add up and add up to a very expensive healthcare system as we know that ultimately is not going to be good for the entire holistic sense.’’   14:19 Qualified students can’t access vital healthcare programs Geoffrey said in 2023, over 13,600 students qualified for a community college program were turned away.  ‘’Today, we sit in a very different time where we have far less individuals expressing interest in healthcare careers as a whole. And we also sit at a time where we have a challenge where so many healthcare programs, particularly at the community college level, which have historically been our biggest supplier of our clinical healthcare roles are capped or they don't have any additional seats currently available. We get into accreditation issues there. We get into faculty student ratios there, but it's a very real issue. So I'll give you an example. In imaging, which is so important to all facets of our healthcare system from a diagnoses standpoint to helping the whole care delivery system to rural, suburban, urban communities across this country, you have, in 2023, the professional association, ASRT, surveyed community colleges. And what that survey said was that roughly just over 13,600 students qualified for a community college program in imaging were turned away…..Just over 13,600 qualified students turned away from community colleges across the country. Now, we know nursing has even worse numbers when it comes to community colleges. And here's the fact these community colleges are not turning them away because they want to. They're turning them away because of accreditation. They're turning away because they don't have enough room, seats, faculty to student ratio, a whole host of things.’’   17:52 All healthcare leaders should mentor  Geoffrey said it’s important to give back and help others to achieve their dreams. ‘’…I think particularly if you are a leader, make sure you're mentoring and that you are giving back to help others achieve their dreams. And if you're seeking a mentor, certainly people that have not necessarily been a mentor, think about mentoring others too. Everybody we know, based on data, particularly in healthcare today, needs a mentor. This is not an easy industry, but it is the most fulfilling industry to ever serve in. But we know that with a mentor, it's not going to be easy, but it certainly can be a bit easier along the journey. And so that's what I would certainly leave you with.’’   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Geoffrey Roche on LinkedIn    Check out VIE Healthcare and SpendMend    You’ll also hear:    The meaning of ‘’Healthineers’’: ‘’Healthineers is the healthcare side of Siemens….Healthineers was a name given that really reflects that our workforce at Siemens…are pioneers in breakthroughs in medicine.‘’ Challenges in staff turnover and hospital leadership: ‘’We have seen larger numbers of individuals at middle management all the way up to senior executive management leaving our healthcare systems. Some of that in all honesty is not a bad thing…. In my opinion, we have had far too much transactional leadership in healthcare as compared to true heart-centered transformational leadership.’’ Burnout remains a very real issue for healthcare workers: ‘’….we're also seeing (burnout) among other professionals and other leaders in healthcare. It's a very, very real issue…, we don't always take care of ourselves because we're so externally people-focused. And so it's impacted across the board.’’ Time is of the essence for staffing and patient care: ‘’…if we as industry don't work to … find innovative and creative ways to join together to talk to the accrediting bodies, to work with the licensing boards, we're going to only further perpetuate that reality becoming far worse. This has a significant impact to patients. This has also a significant impact to the workforce, the existing workforce, because think about burnout, think about moral injury, think about stress. We don't have enough people to help you, everything's on you.’’ What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.
19:41 21/02/2024
Sufficiency in the Midst of Uncertainty | E. 101
Tom Pierce, the President of Integrated Information Systems Incorporated provides valuable insights based on his diverse background in problem-solving, logistics modeling, and consulting.    Introduction Our guest, Tom Pierce, the President of Integrated Information Systems Incorporated provides valuable insights based on his diverse background in problem-solving, logistics modeling, and consulting. The episode explores the impact of technology and human behavior on the supply chain, challenges in decision-making related to expenses and stock management, and the importance of honesty, transparency, and human connections in supply chain management.   Topics Covered The mindset required for effective decision-making in healthcare expenses The social and psychological dimensions of business decisions Transparency and human connections in supply chain management Data quality challenges and human intervention with digital technologies Overseas supply procurement and its implications The importance of truthfulness in buyer-supplier communication The bullwhip effect and technology's role in accelerating it Cost-risk versus schedule-risk: organizational motivations The impact of just-in-time vs. just-in-case inventory strategies   2:45 The Impact of Technology on Problem Solving "Once computers made their appearance, and yes, I am so old that I learned how to use a slide rule and the calculator was in advance, so I'm that old, but as computers came on the scene, the only reason I was interested in them was because they could help me do things to solve problems quicker, more efficiently, all of that. So I've grown up with the introduction of technology into previously very human, very brute force, mental math, pencil and paper, problem solving, but it's very hard to condense 40 years of what technology has done to the ways we solve problems and the ways we create new ones. Everything we did humanly good and bad has been accelerated and amplified by technology.:   6:17 The Impact of Technology on Human Behavior "It's rather amazing how much our computers have been created in our own image and exemplify, manifest the same flaws that we as people exhibit when relating to each other, but it's less inhibited."   10:34 The Impact of Financial Incentives in Organizations "I don't think that's a bad thing. I think people should be rewarded financially and get fairly compensated for their investment in in technology, you know, and people that do well should be rewarded for doing well. I got no problem with that."   13:26 "Just in Time Inventory Practices" Well, if it's not broke, don't fix it. Well, that doesn't mean don't have spare batteries. When my flashlight goes out in the middle of the night, I want to be able to go into my pantry or my workshop and get more batteries, but that's not lean unless you can predict exactly how many batteries you're going to need and then the ideal becomes, "Well, we'll just have an Amazon ready to deliver to batteries same day," and just reduce and reduce and reduce the carrying cost of your inventory, and I blame the Walmarts and the Targets of the world for doing just that. They leaned out their own cost by offloading those costs to their suppliers, so the just-in-case part, right? In case of disaster, well, that's your vendor's problem, because your big and powerful and you can insist, if you want to do business with us, then you've got to maintain stockage objectives and you've got to reply 24/7 replenishing my shelves, because I don't want to maintain a big warehouse. I just want to move parts through.   15:07 Just in time versus just in case "If your only motivation is profit, that's a really good business model for a finance person. Mhmm. It's not a great business model if what you're really trying to do is continuously improve your product and your service and the delivery times and, you know, customer lead times, all that."   19:30 The Deception Game in Business “I need to know when my parts are going to arrive and I need you, as my supplier, to meet that date, because I'm counting on it, but I'm not going to tell you that I'm fudging the date a little bit, because I want to build myself a little cushion, because I'm telling my boss it's going to be here by February, so I'm telling you I need it by January, and you've got sub-tiers and if it goes seven levers down, now you've got people running around like mad people trying to do things six months earlier than they're really needed. And if you're good and successful, it goes through the chain and it ends up on somebody's shelf six months earlier than it was really needed” 22:42  The Bullwhip Effect “The more you fudge, the more you hedge, the less honest you are, you end up with what a lot of people in supply chain refer to as the bullwhip effect, right? You make a slight quick motion with your wrist on the handle and on a really long whip, the tip of it is going to break the sound barrier. You can have that dramatic effect on a really long supply chain as the amplification, and again, technology amplifies and accelerates that.”     25: 19 Predictability in Supply Chains: "Level is more predictable when your forecastability, your coefficient of variance, Ratio of standard deviation to mean is, well, one expert that I trust highly says, when it's greater than 20%, You're entering an area, a quadrant, that they would call unforecastable."   32: 10 The Importance of Trust in Leadership: "I will trust you until you give me not just one, maybe two or three reasons not to trust you. Maybe the answer should be seven or 70 times seven, but my default position is going to be in trust until I have a reason not to trust you. I believe well-informed leaders make better decisions, so there's way too many people that are afraid to tell the boss the truth, to tell the shareholders the truth, to tell the clients the truth, to tell  well-informed people throughout your living experience perform better.”   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Tom Pierce on LinkedIn  Check out VIE Healthcare and SpendMend        You’ll Also Hear: 1. The Impact of Technology on Human Behavior: We discussed the interplay between technology and human decision-making in supply chain management, emphasizing the psychological and social aspects involved. Understanding the mindset needed for decision-making related to expenses, shelf life considerations, stock management, and tolerance for excess stock is crucial in today's rapidly evolving healthcare landscape. 2. Transparency, Trust, and Communication: Honesty, transparency, and human connections are essential for effective supply chain management. We explored the challenges of data quality, the need for human intervention in digital technologies, and the implications of deception and lack of transparency in communication between buyers and sellers. Establishing trust and honest communication is vital for well-informed decision-making and effective leadership. 3. Balancing Cost and Risk: The episode delved into the concept of cost risk versus schedule risk in business and the implications of the healthcare industry's focus on cost and slim operating margins. We explored the balance between maintaining emergency inventories of life-saving equipment and outsourcing supply chain overseas to manage costs, highlighting the impact on organizations' motivations and incentives.   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.      
34:17 15/02/2024
Healthcare Cost Savings: Surprises & Predictions | E. 100
After 25 years and $1 billion of hospital cost savings, Lisa Miller is joined by Rich Dormer, Bryan Covert, and Pandu Mitre to celebrate this landmark episode of THLE.     Episode Introduction  Together, the team discuss the cost savings surprises of 2023 and look forward to 2024. Insights include the two-tiered approach to cost savings goals that all hospital leaders might want to consider, and why difficult vendor negotiations will continue in 2024. The team also review the potential impact of AI on cost reduction, why finding hidden costs always comes back to line-item data, and why every hospital needs a spend data strategy in 2024.    Show Topics   Building strong teams in a post-Covid era Vendor negotiations became more difficult in 2023 ‘’It always goes back to the line-item analytics’’ A two-tiered approach to cost savings goals The hidden cost savings in AI  Vendors will continue to say ‘’no’’ in 2024 Two keys to an efficient supply chain More buying power doesn’t always equate to ‘’best pricing’’      02:26 Building strong teams in a post-Covid era  Rich said healthcare systems are hiring people with a broader skillset that need an accelerated learning curve.  ‘’…one of the biggest things that we saw this year, or I saw specifically was a lot of organizations were building those sourcing and supply chain teams. Where in the past they've been really lean and relying on GPO or other types of resources. But with COVID and the need to really do a lot of contracting, a lot of complicated agreements, most organizations recognize that they really needed to build their teams. But the issue that a lot of them have is that there's really only a limited pool of seasoned players on the market essentially. Therefore, when they look to hire, they're hiring a lot of people that are either early in their careers or they come from a different industry which when we look at healthcare it's really unique and complex. So bringing someone from the manufacturer industry coming in and looking to do a sourcing or some sort of negotiation in healthcare, it's very different. So with these large obviously needed cost savings goals for organizations, these newer teams that are being put together need to really accelerate their learning curve. So we've seen a lot of conversations around the support that they need. Right? And probably the biggest one that we keep hearing is that access to data, really that line-item invoice level data is critical to be able to do these large initiatives that a lot of them are working on now and they struggle to get that information. Because the biggest piece is to really do analytics around it and they're doing it off of projected data or vendor supplied information which is not always accurate. So those are the biggest pieces for a lot of these teams coming in and really trying to meet these aggressive goals that are needed for these organizations to maintain their profitability and not only with analytics and data but also negotiations.’’   12:06 Vendor negotiations became more difficult in 2023 Bryan said utilization and market data are just two elements hospitals can us to combat vendor refusal to reduce costs.  ‘’I think the most surprising thing for me was just how difficult negotiations with vendors became in 2023. To your point and Rich's, point earlier we saw on the hospital side more investment in supply chain teams, probably some of the largest cost savings goals we've seen at our clients throughout the years. Just because costs were going up and they're trying to come up with ways to combat them, the vendors had a really solid narrative. We had 8% inflation; their costs were up. They're also coming out of a time with COVID where a lot of the vendors had to really step up in supply services and crunch time, so they really developed stronger relationships with the stakeholders at the hospital. And then we're seeing in 2023 the vendor is more willing to tell supply chain no to cost reduction, costs are going up and then lean on those relationships with the stakeholders. In some cases have stronger relationships with the stakeholders than supply chain and finance, it was really a difficult time to just negotiate for cost savings because you're really up against a lot of external factors. So for us I know achieving cost savings for our clients more than ever we really leaned into a lot of contract compliance and also a lot of the utilization, implementation, ways that you could improve service, improve scheduling, lower costs that way. But more than ever heading into negotiations you really needed a solid strategy, good market data to combat that. But also more than ever you really need involvement with the stakeholders at the hospital. …. also what we see is our clients who are successful were the ones that were more willing to engage the stakeholders, maybe take a little more risk and look at change and look at consolidation and kind of think outside the box.’’   18:14 It always goes back to the line-item analytics Rich explained why invoice details are vital to understand cost drivers and strengthen negotiations with vendors.  ‘’So it always goes back to the line-item analytics, right? So the invoice details are super important to be able to build the baseline and understand where the cost drivers are and then to be able to negotiate and Bryan, mentioned utilization. Obviously, there's a lot of opportunity in utilization now and it's not just pricing. In some cases we're saving our clients 60, 70% of the total spend for a vendor because they're not using them properly. There wasn't things that were set up that weren't even being utilized and that wouldn't be identified on just a contract review on just a 12-month spend report from the vendor. These are the things that you would get from the invoices and working with the stakeholders and understanding and diving into each one of those applications you'll figure out okay, well we don't need these. Why are we even paying for these? And that's where a lot of the cost savings came over the last year outside of those line-item analytics negotiations.’’   23:59 A two-tiered approach to cost savings goals Lisa explained why a ‘’stretch-goal’’ can help hospital leaders to identify more cost savings.  ‘’….Everyone gets a cost savings goal and they're driving to that, and I think the thing that surprised me this year and we've all talked about it and it's probably a little sensitive. So I will approach it from a sensitive perspective, is that once hospitals have hit those savings goals in the department everything kind of seems to stop. Right? In terms of savings. And so let's say the hospitals hit their savings goals in September, we do see... And we've seen it every year for years and years and years it slows up, unless the initiatives are driven let's say by say a CFO or someone there. Right? They're like, "Keep on going, keep on going." And I think that surprised me this year and I would've thought that everybody with all the losses and all the issues would've just continued to put their focus and would've just continued to drive, drive, drive right until the end of the year. Let's get as much as possible and I know that whether it's goals or incentives, they do drive behavior and outcomes and so maybe hospitals and leaders need to think of two tiered on this like a goal and a stretch goal. I think for me I was surprised to see the let up considering all the losses in hospitals in the…. I was surprised to not see like listen we got to forget my goal, I got to surpass my goal. So for me that was a big surprise.’’   33:55 The hidden cost savings in AI Rich said transparency is need from vendors if they expect to make future cost savings from AI.  ‘’Obviously, AI is being talked about a lot and we're really starting to see some of the first steps and some of our clients recently worked for an IT call center and the AI functionality is going to really take the initial call desks. So this way it eliminates a lot of the costs that would be going to this third party that they were outsourcing. Then what happens is then the remaining calls are more complicated and take longer. So it's actually going to cost the vendor more to support the call centers because all the quick calls that could be taken with them that they're doing now are going to be eliminated by AI. So there's a lot of these disruptions that are going to happen within healthcare, it's coming it's just a matter of when and how quickly but we're definitely going to see them. I mean it's going to be patient financial services, transcription language services. There's a lot of these different that you could see it's going to impact and then there's going to be a lot that we don't know it's coming. But it's one of those where from an organization standpoint, negotiating contracts now, like if there is some pending or soon to be released AI functionality in certain areas, they really should know about it. Because if they're putting a five-year contract in place and there's a replacement lesser cost AI functionality, they would really need to know that beforehand going in because the vendors would probably know that.’’   38:48 Vendors will continue to say ‘’no’’ in 2024  Bryan said hospital cost savings teams need to be prepared for inflexible vendors.  ‘’I think that cost savings teams at the hospitals have to just anticipate hearing no from the vendors more than ever. I think we heard it last year…..I think it's kind of a paradigm shift where supply chain used to come into these initiatives with either some level of benchmarking or cost savings goal and sort of bluff a little bit. "Give us this price or else." And now the vendors are just saying, "Okay. Well no, what's the “or else?" And then it became a question of are we going to look into the “or else” then? Are we going to go talk to stakeholders? Can we really move it? Can we impact this or impact change? But I think now more than ever moving into the new year, you really have to be prepared from the start. You have to get that engagement and think critically about how serious you are taking on a category, get with those stakeholders and really get that engagement and come up with a plan. Because you need to anticipate that they're going to say no and then you have to know what “or else” is and you have to have some teeth behind it or it's just not going to work.’’   42:49 If you’re not in the business of data you’re not in business Lisa explained why a spend data strategy is vital for cost savings in 2024.  ‘’….. My prediction for this year as it relates to 2024 because it talks about data. So I read this quote, and I really loved it, "If you're not in the business of data you're not in business." And I actually think it's data, data, data for 2024. Right? Using data with brave new strategies versus being reactive in your decision-making. So I think that while we've had some advances in hospitals being your supply chain or spend data, I think there's been some movement on how we look at data. I think there's still a big quantum leap in the discipline of data. Anything, in department sourcing, how do we look at spend data from a real monthly approach? Line-item approach? It is going to require either an investment or resources, but I actually think that's the easiest part. I think the hardest part is the change, it's actually putting in that data discipline and metrics and all those things in place. I think that's the harder component, but I just think there's so much money available to hospitals if they just really had a spend data strategy. What's your spend data strategy? So that for me is the prediction for 2024 is it's all about data. ‘’   46:17 Two keys to an efficient supply chain in 2024   Pandu said better communication between internal stakeholders and more effective contract organization will help to improve renewal processes.  ‘’The biggest thing is just communication between internal stakeholders, we see a lot of times where you're working on an initiative it's a large vendor and there's just multiple services coming through. We talked about it a little bit, and you have two different people working on essentially the same initiative but they're looking at two different aspects of the initiative. So they're not aligned, they're not communicating and they're kind of just looking after their own goals and I think that needs to change. I think a formal process that then needs to be put in place is going to help make that change. So having a written checklist with things that you need to evaluate, a list of questions that you're constantly asking, and you have to ask on every initiative and then the timeline to completion. So that everyone's aware of when things need to be done so that they have time to collaborate with each other. And then in addition just organization. Having a repository of all of the contracts that you've worked on in the past, all of the data, all of the utilization reports that you should be requesting as a part of that checklist and then commitments or notes that you're making now when you're negotiating a contract. So you can look back on it a year or two years or five years down the road, which will make your renewal process a little bit easier. So I think there's so much more, but I just wanted to keep that high level.’’   48:04 More buying power doesn’t equate to ‘’best pricing’’ Rich said that most of the time larger health systems are not getting the best value from contracts.   ‘’It really comes down to a lot of the health systems, they're pooling that money together, the buying power. So you would think they're getting the best pricing and a lot of times we've seen our clients and some of the larger health systems, they're not getting the best pricing, they're not even getting even average pricing. And a lot of the times it's because the contracts are so complicated, the services are so different and unique by location that to kind of put everything together it doesn't mesh. Right? So they're trying to fit everything together as quickly as possible when a lot of times these things are not aligned. Right? So like food nutrition services or EVS or medical gases. It's just how are they winding up and how quickly they can line up these different services from even sometimes the same vendor but competing vendors as well. Without that, we've come to it again the line-item analytics and really that contract mapping. Right? So it's a combination of both the line-item analytics, the contract mapping by location. The quicker they can do that, the more money they save. Even if they line up these contracts, most of the time they're not getting the best value. So it's really how quickly they can do that, even though they're so big and they have this buying power a lot of times like I said they're not getting the best rates.’’     Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Rich Dormer on LinkedIn  Connect with Bryan Covert on LinkedIn Connect with Pandu Mitre on LinkedIn   Check out VIE Healthcare and SpendMend    You’ll also hear:    Hospitals need to put in layers: ‘’Vendors and vendor partners dedicate an enormous amount of resources, time, training….they're putting in layers and jobs in their organizations for pricing committees….But how much so should hospitals be putting in those layers that thinking, that discipline that they are doing?’’ The hospital paying half a million dollars for ‘’software on a shelf’’: ‘’There's such a high level of disagreement between hospitals and vendors coming out of COVID where vendors seemed like they're really stepping up and being good partners and they kind of transitioned into “well, we helped you out. Now we need to raise costs because inflation's really high.’’ Focusing solely on contract reviews means missed opportunities for cost savings: ‘’… if you were just to look at a chemo dialysis agreement you would for the most part look at one-on-one, two-on-ones. But if you didn't look at the invoice details and you look at utilization, you wouldn't see delayed start times. You wouldn't see all those inefficiencies …..just reviewing contracts you lose so much opportunity.’’ Changing behavior to incentivizing cost savings: ‘’On the (hospital) side you're limited to just reducing budgeted expenses, that's it …I've hit my goal. If I close a project now, it doesn't do anything for me but if I close it next month it helps me meet my goal next quarter. So then you're actually incentivizing behavior to push off projects, to delay cost savings because people are going to look for their own job safety before anything else.’’ Reducing time for legal reviews. Could AI accelerate contract renewals? ‘’The biggest delay a lot of times is on the legal review, so you have to imagine that if there's an AI component there which would be a lot less expensive than a lawyer reviewing the contracts that could accelerate a lot of the different negotiations.’’ Having a back-up vendor rather than sole source: ‘’... We like sole source, we think there's aggregate discounts, there's reasons why. I just think that having a backup and a backup strategy, …. having a number two in some way, shape or form makes a whole lot of sense too. …I think hospitals have to take control.’’ What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.
51:51 06/02/2024
Challenges and Trends in the Healthcare Supply Chain | E. 99
After labor, the supply chain is healthcare’s biggest expense. Randy Subramany, Director of Supply Chain at New York Presbyterian Hospital, shares insights into 2024 trends and innovations with Jim Cagliostro.    Episode Introduction  Randy explains why there’s more to his role than ‘’bandages and gauzes’’, why people are the most important element of the ‘’three-legged supply chain barstool,’’ and highlights why patient care, decision-making and retaining talent are the top supply chain challenges. He also explains why it takes an eco-system to keep people healthy and how tapping into the power of technology can improve slim hospital margins.    Show Topics   A day in the life of a Hospital Supply Chain Director Caring for patients with complex health needs Challenges in retaining and growing talent  The impact of digital transformation on healthcare Utilizing technology to promote a sustainable economy Supply chain management: improving margins Leadership tip: Going to the Gemba     02:26 A day in the life of a Hospital Supply Chain Director Randy explained the far-reaching impact of the role and his team.    ‘’People think about supplies in a hospital, I'm sure the basics, whether it's through a TV show or just walking through a hospital, you'll see the fundamentals, you'll see gloves, you'll see gowns, you'll see all the different forms of PPE, people think bandages and gauzes, but let's move beyond that now because that's some of the basic things. As a supply chain director, my team is also responsible for pacemakers, for skin tissue that we purchase for a patient that has a severe burn and needs to have emergency surgery, for all of the accessories used in robotic surgeries as well, for grafts and stents and meshes that are used throughout all different sorts of vascular cases. And to give everyone those numbers, to give a number, my team, on a daily basis, is managing 15 to 20,000 case-dependent, unique supplies. To take you through my day, fundamentally, I have 135 wonderful human beings who are responsible for all elements of supply reordering, replenishment, distribution, logistics, triaging, back orders, and really, anything disposable, and some reusable, but mostly disposable that's used on a patient is touching a member of our team. So as I'm sure you can imagine, as I'm sure anyone who's familiar with the hospital can imagine, as I'm sure anyone who's not familiar with the hospital can imagine, the role itself, it's quite impactful.’’   08:52 Caring for patients with complex healthcare needs Randy said that caring for patients with complicated illnesses was the primary challenge.  ‘’But I think the primary challenge that we have, that we will have as an academic institution, is we're seeing patients with the most complicated illnesses and diseases that require, although state-of-the-art and groundbreaking, the most complicated treatments and the most complicated processes and procedures to care successfully for these patients. Of course, fundamentally, in a hospital setting, you're never going to be 100% ever. You're never going to cure anyone 100%. Sometimes care is more important than the cure itself. But putting that aside, I think we're what they call a tertiary coronary academic medical center, which means that we encounter the sickest patients in the world that come to us. So I think the first challenge is we are caring for humans who have very complicated illnesses and diseases.’’   11:43 Challenges in retaining and growing talent  Randy said he expects to lose up to 40% of his experienced team members in the next five years.  ‘’From my direct lens internally, I think the main challenge is retaining talent and growing the talent. I say that from two lenses, I'll say that from the lens of 30 to 40% of my team members are within five years of retirement, 30 to 40% are within the first five years of their career. I think there's a gap. And we're noticing, universally, putting aside the supply chain industry, that talent is leaving the work environment or leaving the market because it's time for people to live on to their golden years and pursue other adventures. But for me, it's like how do I bridge the gap with that talent in X number of years from now where the majority of our workforce or my team will be relatively, it's wrong to say inexperienced, but will not have the same levels of experience as those who just have that anecdotal information of they know that this unit uses this supply. It's not something you directly can teach, it's just something that people learn.’’   17:08 The impact of digital transformation on healthcare  Randy said moving to cloud-based systems will be vital for effective supply chain management. ‘’Why is that? I think it's because we think of, historically, ERP systems as transactional systems, systems that you use to order, sometimes to manage inventory, but as we move to the cloud, there is going to be this recognition. Cloud-based systems are built as well to be more of analytical tools that can offer forecasting services, that can truly offer inventory management visibility that get into a lot of those key metrics and KPIs that supply chain leaders such as myself look for. In the current ERP systems, at least the primary ones used in healthcare, like Infor, Oracle, and Workday, the non-cloud based systems I can tell you from firsthand experience, aren't there yet. And I'm not by any means saying anything negative about the products, they serve a key function of getting supply orders to our vendor partners and getting supplies in our doors. But moving towards cloud-based systems, which I think will be the centerpiece of this digital transformation for hospitals, is of the utmost of importance for supply chain leaders.’’   24:17 Utilizing technology to promote a sustainable economy  Randy explained how a sustainable approach can also help to create a healthier society.  ‘’The last trend I'll say it's really around what we term the circular economy or the sustainable economy. I think when we think of... In the world of disposable supply, it's hard to kind of connect that to being sustainable because disposable, you associate with using once and then throwing away…. but the trend of using technology to accomplish the key tenets of forecasting more accurately to ensuring that what we have on the shelf is exactly what we need….creates a more sustainable environment because we're not over-ordering and we're not producing waste. One of the key things in healthcare we're focused on from a patient safety perspective, of course, is ensuring that an expired supply is not used on a patient for care. Having technology as an enabler helps us to track expiration dates as an example, and by doing so, we'd be better able to make better decisions about what we order, about what our warehouses, whether it's our own, whether it's our distributor, what's being stored in the right quantities, which in the end creates a more sustainable environment for everyone. Of course, we have a lot of great vendor partners who are working on state-of-the-art packaging techniques that utilize recyclable materials. But just to bring in full circle, these trends of utilizing your talent and creating an environment, digital supply chain, one that incorporates elements of artificial intelligence and big data can not only just drive us towards being more sustainable, but in the end, it makes people healthier….. having a healthier world just creates a better place for everyone. … it takes an ecosystem, and it takes a lot of external parties as well to help us get there, but these trends are essential to keeping people healthy.’’   31:50 Supply chain management: improving margins  Randy explained the importance of what hospitals buy and why they buy it  ‘’….when you look at the expense bucket, you have staffing, which is the primary expense, you have the best talent. Hard bucket to touch. The second-biggest bucket though is the supplies and all the efforts that a supply chain management team is involved in. And what I would say is how... Of course, by no means am I advocating for buying the cheapest stuff to reduce the margins, that's not the investment way to think about it. But I think one thing I will say is thinking of a supply chain team as an investment is the right approach to help build bigger margins. Now I say that from the lens of, coming back to my example of spine surgery, sure, we may buy a spine implant at a greater cost, could it yield a better outcome for our patient that reduces their chance of readmissions, which... And I'm not trying to get into the insurance world, which hospitals then get reimbursed less at a basic level if a patient's readmitted. So there are factors that tie to that strategic thought process that requires so many different parties from the revenue cycle, from finance, from clinical care, to be involved and from the billing and coding, all of that ties into the supply chain. So I think thinking about supply chain from that operational lens as an investment, it's like, "What do we actually buy. And why are we buying it?" And of course, economies of scale come into play. If you can standardize, and you know this, Jim, if you can have your physician and clinical teams on board with utilizing as much stuff from one supplier or one vendor over another, it naturally will just yield the economies of scale and reduced rates. ‘’   35:47: Leadership tip: Going to the Gemba  Randy said going to the source and engaging with people is a pillar of success.  ‘’So what I would say is a lesson I try to embody and carry every day, it's centered around this theme of going to the source. So when I say that, and I mean, like literally or geographically, if there's an issue on a unit and a hospital, going to the unit, engaging with my team who's there to maybe help resolve supply chain need, engaging with the clinical team, again, as human beings, are there to help care for a human. But also, when in critical emergencies, as humans, we can't help but feel you have a variety of different emotions that go into the care of caring for others. So I would say as leadership lessons is going to the source and engaging with people. I think fundamentally it's working with people, that is the pillar of my success, or I dare to say, my success is being able to work with others. And when there's a moment to praise someone, when an opportunity arises to improve something, going to that source. My source just so happens to be a clinical unit in a hospital. And you know what? Going to the source, it's more often than not gratifying because then you really get to see, hey, my team orders this product, here's how it's used to help make life better for this person who's receiving care. So I think Toyota coined it as going to the Gemba, so I'll leave our listeners with go to the Gemba.’’   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Randy Subramany on LinkedIn Check out VIE Healthcare and SpendMend    You’ll also hear:    A focus on the ‘’three-legged bar stool’’ of people, processes, and tools: ‘’People is the most important bucket of what the supply chain does here.’’   Why decision-making in patient care can be a challenge: ‘’….we need to have the right people per se at the metaphorical table or the virtual table to make those decisions. But getting everyone to one direction is not always easy.’’   Supply chain is at a tipping point: ‘’But I think we're approaching this tipping point in supply chain, specifically in the healthcare and even in the hospital sector where innovation and technology as an enabler is going to come to the forefront.’’   The impact of AI on payment systems and profit margins: ‘’Many operate at less than 3% (margin). So when you think of being able to pay your partners, your suppliers or vendors quicker, but to get a greater discount, it just directly connects to the bottom line.’’   Successful change management incorporates listening to feedback: ‘’….allowing the team to be heard with their feedback, even if their feedback upfront is resistance, finding some layers of compromise. … team members are rational and they will understand why the new process, one that uses technology more, will make things more efficient. And they realized that the process became 30% shorter per se, approximately 30% shorter, minutes-wise, which gave them time back to assist with other responsibilities that were directed to patient care.’’ What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.  
38:33 31/01/2024
$1 Billion in Hospital Financial Improvements | E. 98
A focus on frontline innovation has kept VIE Healthcare at the forefront of hospital cost savings for 25 years. Lisa Miller shares her formula for success with Jim Cagliostro.    Episode Introduction  Lisa outlines how getting to the line-item details in purchased services was the key to early success, the ‘what-if’ questions that led to patents, and why hospitals should never settle for 10% in savings when digging deeper might lead to 25%. She also explains why letting the data speak takes the emotion out of vendor meetings, and why hospitals need to work with companies that will ‘’run after every dollar’’ of cost savings.   Show Topics   25 years of adapting to change in healthcare Paying attention to detail and a focus on data Cost savings innovation comes from ‘’what-if’’? Hospitals have one shot at cost savings Allowing the data to speak at contract renewal A comprehensive cost-savings solution with SpendMend     03:50 25 years of adapting to change in healthcare  Lisa said VIE had focused on finding cost savings in purchased services from the beginning.   ‘’25 years ago, I knew I wanted to be different. So the difference was, for me, that we would go into an AP department and we would copy invoices. So we literally would say, we don't need anything from your team. We're not going to be disruptive. We're going to go in, we're going to copy invoices, and then from those copying invoices and copying the contracts, we're going to find cost savings. So you won't even see us. We're going to, in the back room, get the data and we're going to come back to you. And that works great. I felt like that was a big differentiator because working with the CFOs and the COOs are like, "Really?" And I'm like, "Yeah, just give me a day, give me two days, we'll bring a couple of people in, and then within less than two, three weeks, we're going to already have opportunities." So that was, in my mind, the least amount of friction that we could get to working with the C-suite, and that, for them, too, they can get buy-in. Obviously, they have to task their team with this. So the most they would have to do is tell somebody in accounting, they're going to be onsite and they're going to copy invoices and contracts. That was the worst case scenario. …. So what happened is, accidentally, because we copied all the invoices, we were 24 or five years ago already started to look at purchase services because others in this space, other consulting firms would ask for a PO detail report and they would focus on that PO detail report for their cost savings. So the purchase services would come up as just the header data and a total spend… they would never even look at it.’    07:08 Paying attention to detail and a focus on data  Lisa said a desire to do the work and getting down to line-item details are two differentiators for VIE.  ‘’…we are so detailed-focused, and so when you asked your initial question how we see change or how I view that, it started with how do we support hospitals for success? And so my lens on it was always to make things easy to... be easy to work with, get the data. And then over time, as people saw, like what you said, just our desire, our roll up your sleeves, we get to the details approach. We're not looking at ratios. In the past, we've achieved 7%, so we are going to give you 7% savings. It was always about their data, their line-items, their detail. When we show an opportunity report, it is down to the details. And so that's a great point. That's our differentiation. So fast-forward, we would get the invoices. We had a team of people on the backend just entering line on details. And so our work was always so different, when our hospitals saw that work, like, this is work that we've never seen before. And it's because everything matters, those details matter.’’   08:22 Cost-savings innovation comes from ‘’what-if’’? Lisa explained how ‘’what-if’’ questions resulted in innovation (and patents) in cost savings.  ‘’It's this, I love what if questions, and that what if question really got me down the road of finding a different solution. The different solution was take an off-the-shelf OCR tool and I had to search literally globally for the right OCR solution and reverse engineer it and have to... We code invoices. We had to learn a system, we had to code invoices, we had to bring people in and take a totally different view on it, but it was difficult. And I had people telling me, "You'll never be able to do this. You'll never get a patent." We got several patents. And it was such a great lesson to go through the process and to have people like Anthony who came on board and, of course, Pondu and Rich and Brian, who've kind of been part of this process. But now to have patented technology, to just have a different vision for our work, and to keep pushing forward. To stay ahead, for us, so we can deliver a differentiated result. So one of the things I've been really thinking about a lot is why choose us, right? And there's other people, other companies, and they're doing everything manually. We're automating it. Now we can get to savings in a much quicker, expedited, rapid way, so hospitals can get results.’’   10:55 Hospitals have one shot at cost savings Lisa said health systems have to get it right at contract renewal, and that means getting to the line-item details.  ‘’But I've been thinking about why this matters. And so, the one area where I think it matters the most is that hospitals do have so many things that are going on, so many more competing priorities. So they've got one shot at this contract renewal. They've one shot at looking at this cost savings. What do you want? If you've got this one shot, do you want to just grab 10%? Or do you want to have the company that's going to roll up their sleeves, get to the details and get them 22%? Just because you get 10% of savings, sometimes everyone's high fiving, but what if that should have been 22 or 25? So the big thought that I've been coming to is you got one shot at this agreement, don't you want to... Let's do it right. And again, I go back to this differentiation of for us is that every single project is not trying to get through it. We want to do it right. And that, to me, is a big differentiator and how we look at the market. Let's do this right? You may not be doing this contract again for a few years. Let's get it right. With our backend technology and automation and our systems, we can get to everything we need to do quickly so that we can have the conversations.’’   13:22 Allowing the data to speak at contract renewal Lisa said taking the emotion out of vendor meetings can help to expedite cost savings.  ‘’And look, sometimes those conversations maybe with the vendors are difficult, but sometimes, I often say, "Let's take the emotion out of it and just have the data." I'm really not trying to have any kind of difficult negotiations. They are trained negotiators, and hospitals need to understand that. But if we can let the data speak, take the emotion out, and really compress the timeline. Remember the vendors are trying to expand the timeline, we're trying to compress it. But if you let the data speak, hopefully the data gets to internal collaboration with clinicians and administrators and physicians. And then it gets to, with those negotiations, the utilization, the benchmarking, the thinking around why this contract needs to look a certain way, is done through the data and not done through emotion. And that's what I think is most important.’’   16:23 Offering a comprehensive cost savings solution with SpendMend Lisa explained how VIE’s services have expanded since being acquired by SpendMend.    ‘’…with SpendMend we're able to add profit recovery, which is the core offering that SpendMend has started, which is really key because this is the number one provider of an AP audit, recovery audit is SpendMend so we're able to add that offering. And a lot of the data already comes from what that work is and that core service line. So, we can get that data from those profit recovery audits, which makes onboarding us for purchase services, PPIs, or med-surg just that much more faster because we have the data. And then, finally we have pharmacy. And pharmacy at SpendMend is truly on the cutting-edge, right? So we've got pharmacists, pharm-Ds that support hospitals in their 340B analysis, support them in their cost savings, cost optimization, and we have Trulla that really is a very forward-thinking technology and service that allows them to protect and order in a way that optimizes those costs on the front-end. And then, we have Rebate Insight of course, and that's really making sure our hospitals are getting those rebates, which is really key. So, you put everything together, one solution, one offering, and under our one company, so we're not subbing out, we're not looking to pull other services into under one company: we can come in and deliver a complete cost savings initiative from end-to-end, and a hospital can know that every single dollar is being looked at, right? …From pharmacy, to PPIs, to purchase services, profit recovery, we can do it all and not need anybody else outside. We've got the experts, the team, the technology, the templates, the strategies, all under one house. So for me, that's tremendous.’’   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Check out VIE Healthcare and SpendMend    You’ll also hear:    The VIE Healthcare difference:  ‘’When people say, oh, "Well, what's the difference between you and all the other companies?" I often say, "…my team's been looking at invoice data for 25 years." And it just happened accidentally.’’   Innovation in cost savings isn’t always black and white: ‘’There are going to be new things. But there are principles, and models, and strategies that are very successful. …Sometimes I have to ask people to live in the gray.’’   Applying critical thinking in new areas leads to cost savings: ‘’….we apply some critical thinking to the data, or there's no utilization, … or we have some templates and some models that are very, very successful. And that can be applied across the board as we look at... new IT agreements or new technologies…’’   Getting the most out of every single agreement: ‘’….if your hospital had this one opportunity with this one agreement and with time so short and the competing priorities, what level of results do you want if you've got this one shot? And if you're going to open up these agreements, pick the company that's going to run after every dollar for you.’’ What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.  
30:28 24/01/2024
Coaching for Healthcare Leadership | E. 97
Healthcare is in a time of radical and rapid change. Alan Weiss explains to Lisa Miller why coaching is a sign of strength and how all healthcare leaders can benefit from it in an ‘’age of great transition.’’   Episode Introduction  Alan explains why the best time to start something is always now, and how the most successful people in every field of life engage a coach to help them achieve their goals. He also explains why there are only ‘’new realities’’, rather than a ‘’new normal’’, why innovation has to come from the frontline, and shares his predictions for the healthcare sector in 2024.    Show Topics   ‘’If you want to start something, do it’’ There are only ‘’new realities,’’ not a ‘’new normal’’ Coaching is a sign of strength Private sector versus healthcare: one key difference Innovation has to come from the front line The top three skills for successful leadership  Healthcare predictions for 2024      02:58 ‘’If you want to start something, do it’’ Alan said the key to success is resilience and agility, not waiting for all the information you need.  ‘’Well, if you want to start something, do it. Because nobody has all the information they need before they begin. I've been consulting for 35 years with Fortune 500 companies, and then, as you said, with consultants and entrepreneurs around the world. And I've never started with all the information I'd like to have. And even the information you start with that seemed perfectly helpful, turns out to be either untrue or it shifts or some new development occurs. So the first thing is if you want to start, just start, and have the confidence in yourself that you can be light on your feet and adjust to the times. The second thing is that even if you think you have a long-term project, you still have to start today. And so I've written 60 some odd books and they're in 15 languages. But I've never said to myself, "Well, I'm going to create a book next year. I have a publishing contract and I have a deadline." If I get a publishing contract and the deadline, I start writing the book now. And so there's no time like now. And there's no time like the present, is the old hackney phrase, but the fact is it's true. And the fact is the key isn't having everything you need to start, the key is resilience and agility as you move forward.’’   05:46 There are only ‘’new realities,’’ not a ‘’new normal’’ Alan said today’s leaders need coaching to make clear discriminations in an age of great transition.  ‘’….. There's no return to normal. There's no new normal. What you have are new realities. And the new realities are going to change every day. We're in an age now of great transition. We invent things more rapidly than we can intelligently use them. Nobody really knows about ChatGPT. There are some people lined up out there behind Chicken Little waiting for the sky to fall. We're all going to be eliminated by AI. And of course that's ludicrous. But we do have to understand what's effective for us or what isn't, so what leaders have to do is decide. And this requires discrimination. It requires a clarity of purpose. What is appropriate for their organizations and what is not? For example, I'm on a computer right now with you. And I probably use 20% of this max capability, 20%, but to 100% effectiveness. The other 80%, I don't care. My iPhone here can edit movies, for God's sake. I'm not ever going to edit a movie. But I am going to take pictures. So we have to decide as leaders, what is best for our organization? What's best for us? And that's no easy job. And that's why people need coaching. And they don't need technical coaching. They're not going to delve into the innards of a computer or code. What they need is coaching about their profession and about their own capacities so that they can make these clear discriminations about what is best for them personally and what's not.’’   08:42 Coaching is a sign of strength  Alan said people who reject coaching are generally fearful of appearing vulnerable or in need of help.  ‘’The best people in the world, the best athletes, the best entertainers, the best business people, the best academicians, you name it, all have had coaches or multiple coaches. Marshall Goldsmith and I wrote a book together called Life Storming, and he very graciously said he is the best executive coach in the world and I'm the best entrepreneurial coach in the world. So I readily agreed to that. That's fine. But the fact is, between us, we've observed a hell of a lot. And the fact is that people who reject coaching are generally fearful. They don't want to be vulnerable. They don't want to be seen as needing help, and so they get worse and worse because they don't get help. They breathe their own exhaust. That's the volition part. But people who do see coaching as making them stronger and stronger, get better and better. And so I think while the medical community has come a long way from the time when doctors were Gods and nurses for example couldn't talk to them, while they've come a long way, I still wouldn't nominate them as being on the leading edge of innovation and accepting coaching and being light on their feet.’’   14:03 Private sector versus healthcare: a key difference Alan explained why the medical sector can learn a lot from the private sector about customer service.  ‘’This is the difference between medical and the private sector, last night we flew home from LA. Well, it was one 30 in the afternoon, but we got in here at night in Boston. And we fly JetBlue. JetBlue has superb service. They have these nice little pods in first class. We love it. In the waiting area, about 30 minutes before boarding, a JetBlue employee says, "Look, folks. I'm sorry to say..." And I'm thinking, oh my God, a delay. "I'm sorry to say we've learned that this plane's internet is working properly. It landed and they told us that. So why don't you download anything you need now while you're here, because we have free wifi, so you'll have it on the plane."  Now, normally you get in the plane, the wifi doesn't work. You say, oh God. What'd they do to it? But that's how you handle people. You tell them, we know we have a problem. Let us try at least to ameliorate some of the effects of it. Nobody comes out in a doctor's office, any kind of specialist's office and says, "Listen, your wait time is 42 minutes." They don't do that. If you're on the phone, if you're on a damn phone line waiting for talk to somebody at AT&T, they'll at least tell you you're number six in line, or whatever it is. But this is still the godlike thing with doctors. So they've got to overcome that.’’   17:57 Innovation has to come from the frontline Alan said the only way for leaders to understand what’s happening in their business is to find out for themselves.  ‘’Well, recently the new head of Uber decided he would take a car out and be an Uber driver for a couple of nights. And he was in San Francisco and he got a fare to go over to Oakley. He crossed the Bay Bridge. And the Bay Bridge is a disaster, and it took him an hour and a half to get back. And he realized that his drivers, who were not allowed to pick up in Oakland, just deliver people there, couldn't make much money that way. They wouldn't take fairs to Oakland. So he changed the rates for them. But he had to find that out by doing this himself. I was on a Delta flight once in first class, and the guy across the aisle from me had three flight attendants helping him out. Now, normally there were two flight attendants in all of first class. So I call went over and I said, "This guy's an executive on Delta, right?" So he's the CEO. I said, "Really?" I said, "So what's going on?" He said, "Well, he's wonderful. He flies Delta to see how the service is." I said, "Give me a break. If he wants to see other service is, you're got to be sitting in the back, and you got to be incognito. Do you know his schedule?" They said, "Oh, yeah, they tell us what he's coming on board." So that's worthless. Absolutely worthless. He was treated like a king. He doesn't know anything about Delta service. ….And I think that innovation comes from the front line. You have to have people interfacing people.’’   21:01 The top three skills for successful leadership Alan explained why making hard decisions, a sense of humor, and exceptional communication skills are vital for leaders.  ‘’Well, you can read forever about leadership skills and traits and needs. And if you go on LinkedIn, you find all these bizarre charts. I mean, if a leader consulted the chart, the leader wouldn't be able to lead. The leader would be spending all day looking at the chart. So here's what I've found. I have found that you have to be willing to make hard decisions. You need to fire people. You need to say, "We're not doing this." You need to say, "This isn't working, and so despite our investment, we're going to end it." You need to make the hard decisions, because nobody else is. The second thing is you need a very pronounced sense of humor. Because humor relieves stress, and it helps keep things in perspective. And with rare, rare conditions only, nothing that's going on is going to mean the failure or success of the business. And so you need to keep things in perspective and don't panic. You can't become Chicken Little and say the sky has fallen. And the third thing is you need superb communication skills in writing and orally, and therefore, you need a very, very excellent vocabulary. You need to be well-read. Too many people can confine themselves to their fields. The world is too integrated right now. The world is too reliant on a variety of factors. And so you cannot just sink yourself, drill down into your specialty. You have to know what else is going on.’’   25:05 Alan’s healthcare predictions for 2024 Alan shared his top three predictions for the sector in the next 12 months.  ‘’I'd say that you're going to find more and more reliance on different kinds of people and different kinds of interventions. People going to storefront clinics, people going to nurse practitioners, people talking to their pharmacists, people going on telehealth, and so forth. That's going to spread and spread because it's easier, it's somewhat less expensive, and so forth. So we're going to see a lot more of that. I mean, that's a great opportunity. But the problem with that is you have more and more variety and chance for bad results. I mean, not every pharmacist, for example, has been schooled in how to deal with somebody on a patient kind of a basis. They can give recommendations about things. That's one. I think the second thing is that there is a lot of skepticism about healthcare right now because of Covid and because of the combination of medical disagreement and political disagreement that went into Covid, people are not as faithful. They don't have the same faith in the medical establishment that they used to. They think that some of that was guesswork, and they think that some of it was unnecessary. Some of the advised restrictions were too great, both by physicians and by politicians…,And so I think the medical community has lost some respect that might take a while to regain.  And I think finally, we're going to have to see changes in the bureaucracy of the system. In other words, I have seldom talked to any doctor, either one of my doctors or a doctor I was dealing with for other reasons, who has not complained about the reimbursement system. Who has not complained about the paperwork system. Who has not complained about spending more time on filling out forms than meeting with patients. We're smart enough to change that.’’   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Alan Weiss on LinkedIn Check out VIE Healthcare and SpendMend    You’ll also hear:    How healthcare is changing radically, and for the better. ‘’And so you have this wide variety of options today, as opposed to quote-unquote the old days when I was young, either a doctor came to your house for about $6 and with his black bag. There were no hers then. It was his black bag.’’ Why the medical community needs to accept coaching. ‘’I think that the medical community hasn't accepted coaching as it should. I think that's changing. But I think it needs to change a lot faster because the medical profession is changing a lot faster.’’ The place of doctors may be usurped: ‘’Doctors better watch it. Because of what we talked about a few minutes ago, there are others who are going to use their practices, and they're going to find themselves in tough straits.’’ Innovation has to be looked at in terms of risk and reward. ‘’There's no decision that we make that's an important decision that doesn't have risks that we have to take care of and manage. But William Penn said once, "No cross, no crown." So if you're willing to take prudent risk, you're likely to get a good return.’’ Why healthcare has to deliver the care that patients are paying for: ‘’I'm not a doctor, but I will tell you that I think we have to be careful that the system is providing the kind of healthcare that we deserve and that we're paying for, and not frustrating people who are in the system from providing it.’’ What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.
32:33 17/01/2024
Transforming Healthcare Thought Leadership | E. 96
The pandemic changed the face of healthcare as we knew it. Expert marketing strategist Lisa Larter explains why every hospital leader needs to rethink their view of thought leadership to Lisa Miller.    Episode Introduction  Lisa explains why thought leadership is essential in the era of Doctor Google, why different is better than better, and the importance of an online presence for healthcare leaders. She also highlights the 3 R’s of reviews, referrals and reputation, the importance of truth telling, and why every thought leadership strategy should begin with the end in mind.     Show Topics   Reimagining healthcare thought leadership  All of us have the same Doctor – Doctor Google Every healthcare leader needs their own brand Focus on your patients, not your peers Reputation is the driver behind success Effectively responding to patient reviews  Managing patient expectations is key to thought leadership Begin with the end in mind     03:25 Reimagining healthcare thought leadership  Lisa said thought leadership is a vital part of patient care ‘’So when a hospital commits to thought leadership, not only is it a great tool for people to find when they're searching for information, but it's also a great tool to use as part of their patient care strategy. So if I'm someone who is recently diagnosed with let's say cancer, or diabetes, or a heart condition, it doesn't matter what it is, if a hospital has done a great job at creating thought leadership, they should have an area that they can direct me to that educates me on what to expect, that reassures me, that informs me, that really answers my most common questions and prepares me for the journey that I'm about to go on. Too often, I think people go to a doctor and they get some type of a diagnosis, and then they go home and they try to figure things out on their own. And I think that hospitals that are really, really committed to thought leadership are doing it so that one, people can find the information. But two, they can prescribe the information as part of their patient care strategy.’’   12:03 All of us have the same Doctor – Doctor Google Lisa explained why an online presence is essential to prevent misinformation.  ‘’The first line of defense for all of us is Google. And before we've even seen a doctor, we're asking Dr. Google to tell us what's going on. And so if you understand anything about SEO, you understand that when somebody types a query into Google, you need to match the query in order to show up on the first, second, third page of Google. And if you're not creating thought leadership, then there's no way for your expertise, your thought leadership as a doctor to show up there. What might be happening is a mommy blogger who is passionate about a particular ailment because she had it or her mom had it, has been blogging about this thing. And she shows up there, because she's written more about it than an actual expert who is highly skilled and trained on the same topic. And so what happens is we go down these rabbit holes of reading information, and we don't know what is misinformation and what is legitimate information. ….so you can find whatever it is you're looking for, but that doesn't mean what you're reading is scientifically backed and/or was put together by a professional that really knows what they're talking about. And so I think Dr. Google is a scary thing, but it's the default.’’ Today's healthcare systems and hospitals, especially in rural communities, are slower than ever to service patients in need. And so when you're sitting at home and you're not feeling well, and you have to wait weeks or months to get in to see a specialist, what do you do? You talk to Dr. Google.’’    15:24 Every healthcare leader needs their own brand  Lisa said healthcare leaders need to make it easy for prospective patients to find them.  ‘’…. when Covid hit, a bunch of doctors, national, local, rural were thrown into the spotlight, because people were looking for information. They wanted to understand what was happening in the world. And that is not something that we've seen as much of before in our lifetime. And so I think what happened during that time is there was a bit of a shift, where we now look to doctors, clinicians to be their own subject matter experts. And we look at their personal brands as a consumer. And so a doctor may work for a healthcare system or a hospital, the same one for their entire life, or they may change, but what doesn't change is their body of work and their knowledge. And so I look at doctors and clinicians like experts of their own standing. And if they don't put their own platform out there, and show you who they are, and what they're about, and what their areas of expertise are, then it makes it hard for you to choose them…….And so if you want to control the impression that people have of you, you need to make it easy for them to find the information and find the story that you want them to know. And I think too many people are behaving like they used to behave before the internet, and they're assuming that the patients are just going to come.’’   23:58 Focus on your patients not your peers  Lisa said building a brand should be focused on patients.  ‘’It's hard to get started. And you know why it's scary for so many of them? It's because they're concerned with what their peers are going to think instead of what their patients are going to think. They want it to be all academic, and scientifically backed, and perfect, and that's not what the patient is looking for. And so when you are building this body of work, you're not building it for peer review journals, you're building it for patients. So you want to talk in layman's terms, you want to talk in language that makes it easy for your patients to understand who you are and what you do. That's not to say that you can't write academic pieces that are a bit more scientific and fancier in nature. But I think you have to think about who the audience is that you are creating this thought leadership for. And you're not necessarily creating it for your peers. You're creating it for your patients.’’    29:09 Reputation is the driver behind success Lisa explained why referrals, reviews and reputation are essential to building a brand.  ‘’….your reputation is really the driver of whether people want... I mean, why do some doctors have month long, multi-month long wait lists for people to get in to see them, and other doctors you can get in tomorrow? It's because some doctors have such stellar reputations for doing what they do, that people will wait forever to see them. And  so how do you build a stellar reputation? First of all, you need to do good work. Second of all, you create a body of work. Third, you want to ensure that when people are referring you, that you have the recommendations that support the work that you do.’’   30:44 Effectively responding to patient reviews Lisa said responding to positive and negative reviews builds trust and credibility.  ‘’…. if somebody writes a nice review, get in there and respond, and thank them for the review. And if somebody writes not so nice a review, get in there and acknowledge that you would like to have a conversation with them. If it's positive, get in there and have the dialogue. Thank them, acknowledge it. Go all out. If it's not, try to take them offline. Try to get them to call the office, try to get them to call you. Try to leave a comment that says, "This is not the experience that we want you to have. Could you please call our office so that we can try to fix this for you?" You want to do whatever you can to protect your reputation. We all know there are people out there that are going to write really, really bad reviews. It's going to happen. And sometimes, you're deserving of the review, and a lot of times you're not deserving of the review. And so the best that you can do when you don't have a good review is at least acknowledge it and offer to have a conversation with the person. But if you show up regularly and you respond to reviews, and people see you showing up regularly and responding to reviews, it creates more of a sense of trust and credibility that you really are who people say you are, because you just keep showing up. You show up in the review space, you show up in your thought leadership, you show up online on your website, you show up on social media. It makes you a real person, and that makes you way more attractive.’’   34:36 Managing patient expectations is key to thought leadership Lisa explained why honesty can help to build patient relationships and trust.  ‘’Sometimes, a patient's experience is not going to be positive because that's the protocol. There are some treatments, there are some X-rays, there are some things that you have to do when you're sick that are nasty, they're not nice, they're not fun. And if somebody is writing about that because they had a terrible experience, but it didn't matter what they did, that experience wasn't going to be positive, then you have an opportunity to get in front of that and manage expectations upfront, because now you know what some of the trigger points are. And you can actually say to somebody, "This is going to suck. This is going to be uncomfortable. This is going to be painful. You are not going to like us when this is done. Here are some techniques or tactics or things that you can do to make this easier. And I think sometimes, we're afraid to tell the truth. We're afraid to tell somebody this is not going to be a pleasant experience. And then because they didn't know it wasn't going to be a pleasant experience, you end up on the other side of it writing a review, and you're upset about the unpleasant experience, where if somebody had told you upfront, "I hate to tell you, but a colonoscopy isn't fun," if somebody actually let upfront what to expect, then maybe you wouldn't be so upset with the procedure or upset with what you experienced.’’   37:35 Begin with the end in mind Lisa said getting clear on your personal brand provides a starting point for thought leadership.  ‘’I think if I could steal from Stephen Covey, begin with the end in mind. Think about who you're trying to be and what you want to be known for from a thought leadership perspective, when you begin with the end in mind and you get clear on how you want your personal brand to be and what you want your thought leadership to look like, you have a starting point. But most healthcare practitioners are not marketing experts, and so I would recommend that you work with somebody like myself who is good at developing a marketing strategy. One of the things that we do with a lot of our clients is we help them to create a strategic marketing roadmap, and we help them to actually get the ideas out of their head and create a plan that is both strategic and tactical so that they know what to do next. It's never going to happen on its own. And I would say that one of the things that is the most challenging about creating your own thought leadership is you are so close to what you know, that you often don't know what it is that other people don't know. And so you're like a fish in water. You don't actually realize some of the simple things that you know that are highly valuable to other people, because you think everyone already knows it. So I would encourage anyone who is listening who wants to really think about thought leadership, to have some type of an advisor to help them on the journey. And then if you're listening and you're an executive in healthcare and you're thinking about, "How do I do this for the hospital?" You really need an overarching strategy. And I would start with one department, one aspect, and build it out as a pilot. And then I would look at how you can build that out throughout the whole organization.’'   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Lisa Larter on LinkedIn Check out VIE Healthcare and SpendMend    You’ll also hear:    Leverage the thought leadership of your team: ‘’If you're proud of your doctors and clinicians, and you believe they do good work, then bring that to the forefront. It's a powerful way for you to improve your patient experience, to build confidence, to make your practitioners all feel like their thought leadership matters.’’    Physicians need to take their reputation into their own hands, but how can they achieve that? ‘’Some clinicians and physicians are going to be really comfortable public speaking. They're going to get on TV, they're going to show up on Twitter spaces and have debates about this, that, and the other thing. But other doctors, maybe they're going to be better at just recording short videos, or maybe recording podcasts, or maybe writing content.’’   Why different is better than better: ‘’…if you're just doing the same old and you're not thinking differently about your thought leadership in the healthcare industry, you are going to fall behind.’’   Putting a piece of paper on a pile: Why publishing online is essential to promote your personal brand. ‘’Every time you publish something online, it doesn't matter what it is. Think of it as you're putting a piece of paper on a pile. And every single time you add something to the internet, you're adding another piece of paper to that pile. Your personal brand stands on top of that pile. So the bigger the pile you have, the more visible and easily sought out you become. The person who's got 1,000 pages in the pile, it's a lot easier to find them than the person that's got two.’’ What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.
41:27 10/01/2024
Why Hospital Profit Recovery Audits Are So Important | E. 95
As hospitals continue to face rising costs in 2024, David Hewitt, Snr VP of Sales at SpendMend, highlights the importance of recovery audits, and the SpendMend difference, with Managing Director Lisa Miller.   Episode Introduction  David explains why SpendMend carries out audits every 90 days, and how the company’s deep expertise delivers results within three weeks. He also outlines the importance of recognizing patterns and trends in data, how a snow accumulator saved tens of thousands of dollars for one hospital, and why every CFO should care about recovery audits.    Show Topics   Why recovery audits are vital for hospitals Insight and visibility: the SpendMend advantage SpendMend: Deep expertise and results within three weeks A recovery audit case study: snow accumulators Why every hospital CFO should care about recovery audits Understanding the patterns in your data      02:17 Why recovery audits are vital for hospitals David said SpendMend offers insight and visibility, carrying out audits every 90 days, versus every other year.  ‘’Time is our biggest thief, right. And it doesn't matter what industry you're in, what sector you're in, you're always going to have financial leakage. And the best way I can describe it is, you take a cookie, and you break that cookie in half, you have two very large profits, but if you take that cookie year over year and break it over the same broken process and clean those up at the end of the year, those crumbs, that's a significant amount of money. …We audit process, not people. Okay, we're talking one 1/10th of 1%, so 99.99% of the time, the process is done. But anytime you have human interaction and technology or a handshake in your procure-to-pay process, there's always a likelihood for financial leakage, right. And in healthcare…it’s very unique. It's niche. SpendMend offers insight and visibility. In healthcare, they've done kind of recovery audits every other year or every third year, where at SpendMend, we do it every 90 days. We kind of stay on a continuous basis. I used to play sports, and when I was a freshman I wasn't very good with my left hand. So I used to watch film or I used to work on getting my left hand strong. Well, I can assure you, as I progressed my senior year, I didn't have to watch that same film. There are other things I needed to work on or other things that I saw, and that's the real value of doing a recovery audit, of having that third party or that best practice and that safety net's more real time so then we can kind of fix it concurrently than retrospectively.’’   07:23 Insight and visibility: the SpendMend advantage   David said it’s not what you find in a recovery audit, it’s why.  ‘’The biggest advantage that I like to call at SpendMend is our insight and visibility. And what I mean by that, anyone can tell you what they found and how they found it's the why they found it should matter most. Educating upstream or downstream because 9 times out of 10, everything falls on APs lap, but they're not the single source of truth. You have to go back to what was harboring that control gap to actually implement process improvement. And we provide you with that education. We're not just giving you the dollars and cents, we understand cash is king and we're really good at that, but it's more so understanding what was harboring that control gap. To give you that go forward business intelligence, 'cause you have to understand what happened in the past to give you that education going forward, and that's the real difference at SpendMend. We're going to provide you value, not just substance, and we actually back that up. So when we come into engagement, there is no bait and switch. Our team is there from start to finish, starting with our audit manager and audit supervisor, but more importantly, we provide a vice president of strategic accounts. And why that's important to you is their job to be your eyes and ears outside your four walls 'cause I can assure you the same pain points that you're having other institutions are having. Right now, everyone's going to the cloud, whether it's Lawson or Workday. We understand the nuances in the patterns and trends and the blind spots and that conversion. So having that voice or single source of truth internally to help you navigate that, that's the real value of SpendMend. The dollars are nice, but there's so much more that comes out of it and it's the insight and visibility and understanding how we put data together, because we are matching payments to contracts and that's the value.’’   12:08 SpendMend: Deep expertise and results within three weeks  David said SpendMend’s expertise means audit plans are built from the outset, with rapid results.   ‘’There are only so many suppliers in the healthcare, right. So when we show up, we're going to have a relationship with probably 98% of your supplier base. We understand what suppliers suppress credits, apply credits, offer credits, write off credits, we understand their invoice cadence, their sequences. One of the things that's unique about Lawson is, if an invoice number can only be 14 characters and a lot of people read left to right, so if they're going to truncate, truncate from right to left, not left to because the computer's reading right to left other than we read left to right. So there's this unique nuances difference of these ERPs, but we understand what those tendencies are, what those blind spots are, and that's why when we show up, a lot of our competitors need clients' data to build your audit plan. Our audit plan's already built when we show up, we're backing it into it. We're just using your data to validate our assumptions because I can assure you, we understand where to look and where to find some of those blind spots. And it's because our ability to provide more than just the dollars and cents, we're not looking at your data mechanically, we're looking at it strategically, putting all the pieces together, connecting the right dots between different departments to give you a different view. Once we've received the data in less than three weeks, we're going to start to see results. We can churn data very, very quickly, but again, we don't need your data to get started. We need your data to validate where we already have your audit plan already set. So that's what makes us different is why we can kind of onboard very quickly and we don't need any on the job training.’’   17:16 A recovery audit case study: snow accumulators David explained how digging into details resulted in significant savings for a New York based client.  ‘’When you get into, what sets us apart too is since we take data down to its rawest format, as I said before, many times you see new opportunities. So this one was a client in New York. They had a unique request. They asked us to look at their maintenance agreement and they wanted to really dig into their snow removal and their salt. So as we were going through, again, we have all of the data right, so we had to get the contracts. Some of it was PO, some of it was non-PO, so we had to normalize it and get on it. And there was a clause in there that they would pay a snow accumulator based off of the amount of snow within their county, right. So we saw that, we went through it and we started to do it, it was like, we understand last year, because I lived in kind of the area, so I kind of had a leg up on knowing that it didn't snow that much, but over the past three years, what they were doing to calculate their accumulator, they were taking the entire state of New York, not just the county, and using that as a multiplier, okay. And they couldn't believe the significance. And it wasn't just about the trucks plowing the snow, it was also the salt, okay? Which the salt was very, very expensive. It was a huge savings because there was just a small clause and it wasn't for the entire state, it was just for that county right. And while we were doing that, they had all these facilities and they started to acquire other physical locations outside of the state of New York. They had a facility in Charleston, South Carolina that they were charging snow removal and it hadn't snowed there in three years.’’   23:59 Why every hospital CFO should care about recovery audits  David explained why working with SpendMend isn’t only about the recovery audit.   ‘’So again, going back to the misperception of recovery audit, there are so many more departments that actually touches this is the ecosystem that runs the hospital, your entire procure to pay process, right. There's so many other things that can come out it. Again, when you start talking about utilization of variation, that's when the CFO quirks up. But that is a byproduct of recovery audit. That's what I always tell you, at the end of the day, we're all looking at the same subset of data, we're just looking at it through a different lens. I'm looking at it retrospectively. You're looking at it prospectively. There's real value of getting both sides of the coin of looking at that contract, and that's why the CFO should care, because the best way I can put it's right now we're coming into January. What does that mean? Everyone's wanting to go to the gym, everyone's going to want to lose weight, everyone want to get in shape. So you do your research and you go to a fitness coach, okay. "Fitness coach, I want to get in shape." Okay. He's going to give you an entire program how to get in shape. He's not just going to give you an arm workout. The analogy is we're not just here to give you a recovery audit. We're here to give you the entire, because the data's coming for pharmacy, it's coming for purchase services, it's coming for recovery audit, it's coming for our medical device. It all comes together. It's all the same data, but we've just viewed it very siloed. Now that spend has branched out and acquired these companies, we can give you the entire program. ..That's why CFOs should care because this isn't procuring one-time credits. This is putting a plan in place and ensuring your entire house is cleaned up and we have the data to do it. That's why I'm so excited about our trajectory at SpendMend, because we're not recovery audit anymore. We are that fitness coach to give you that program for financial fitness.’’   27:02 Understanding the patterns in your data David explained how the patterns and trends in data, empower SpendMend’s strategic approach.  ‘’This is actually something I'm very passionate about because at the end of the day, knowledge is key, but knowledge without insight isn't much of an advantage. And what I mean by that is when we show up, we're not going to show up with hypotheticals, right. We're going to show up with your data, and that's why there's so much value of putting both sides of the coin together. We're going to use the pattern and trends in your data to make those recommendations going forward. It's not just benchmarking, right. There's so much more strategic that comes out of that, but you have to get down to that line out of detail, and there's value in that. But putting those together, that's the real value of doing the entire program, of not just looking at it, of showing up, "Hey, this is hypothetical based off of a hospital in your area, you should be paying this," or... It's none of that. There's so much more to that. So now we can use real life examples to arm you with that education. And the best way I can put it, we're not just going to empower you with this information, we're actually going to guide you along the way. ….It's connecting not only the dots, it's the right dots between departments because you have different behaviors, different initiatives, different goals going into 2024, but how we can put that to bring it back to the CFO, that's the real power to impact multiple different departments other than just AP.’’   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with David Hewitt on LinkedIn Check out VIE Healthcare and SpendMend    You’ll also hear:    Ripping off the bandaid: Carrying out recovery audits every 90 days: ‘’…if you're paying a recovery audit firm to find the same stuff over and over, what's the real value? Again, we're just providing substance, not value…..Once we rip off the bandaid, give you that clean bill of health every 90 days, we should see your financial leakages curve go down.’’ The importance of analytics at SpendMend: ‘’Since we take data down to its rawest format for our clients, we can look at it through a different lens and many times you see new opportunities. That's what brings us into the purchased services. We're all looking at the same subset of data, we're just looking at it through a different lens. But that's the real value of SpendMend, having that person that can take that data and drive incremental revenue or different revenue streams by not having to go back to the well on multiple different times.’’ Getting to the details, the SpendMend difference: ‘’In the beginning, cash is king. We understand that the hospitals need it, so do suppliers. So they've gotten very creative of how they're suppressing these credits or offering these rebates or putting these fuel charges or all of these miscellaneous charges onto an invoice. Until you actually go through that line of detail.’’ Providing value over substance for CFOs: ‘’There are lots of unique things that we do at SpendMend, because again, we need to continually provide value other than just substance. It's not about the overpayments and the duplicate payments, it's about the things that they don't have visibility into. It's matching, is the price negotiated the price that you paid?’’   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.
33:46 05/01/2024
Psychological Safety in Healthcare | E. 94
Workplaces are only as safe as the experience of the least safe person. CEO and Founder of Iterum Tom Geraghty, discusses the need for psychological safety in every organization with Jim Cagliostro.   Episode Introduction    Tom outlines the evolution of psychological safety, why diversity will remain ‘’on paper’’ without inclusion, and why high-performing teams possess high degrees of psychological safety. He also explains the principle of the Andon Cord and how behaviors, practices and leadership are the three keys to creating psychologically safe working environments.    Show Topics   Why psychological safety matters The role of the aviation sector and Google’s Project Aristotle Psychologically safe workplaces are more inclusive The unique challenges of psychological safety in healthcare Three keys to creating psychologically safe organizations The Andon Cord principle     05:38 Why psychological safety matters Tom explained why psychological safety is a belief that one will not be punished for speaking out.  ‘’So psychological safety has been recognized across multiple studies, a vast array of studies as the foundation, the core necessary but not sufficient element for high performing teams. And it has got a long history. It first emerged in the literature maybe in the 1950s or so, but it wasn't really until the 90s where Amy Edmondson was studying clinical teams, and she was looking at the mistakes that these teams made, and she was separating high performing and low performing clinical teams and looking at the dynamics between them. And she defined and codified psychological safety at that point in her research. That is to say psychological safety is a belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns, or mistakes. It's essentially a belief that the team is safe for interpersonal risk taking. That means being able to ask questions, to be able to admit your mistakes and ask for help and all that other stuff. But it also means being able to do it in a way that is safe and works for you. So for example, if you have a stutter or a stammer, or if you have a tick, or if you communicate by a sign language or by a written format, that it's safe and okay to do so in the way that resonates and fits you.’’   08:02 The role of the aviation sector and Google’s Project Aristotle Tom outlined the evolution and impact of psychological safety.  ‘’I think if you look back at domains like aviation, back in the 70s and 80s, aviation was probably one of the first industries to really recognize that as a result of analyzing disasters, they recognized that either poor communication or lack of communication or miscommunication was a primary, if not the primary causal factor in loads of disasters, including things like the Tenerife air disaster and things like that. So aviation has got on board, if you like. Then with cockpit resource management turned into crew resource management, and then we skip forward to the nineties with Amy Edmonton's work. And then in 2013, Google Project Aristotle came up. Julia Rosovsky's team did a bunch of research on teams inside Google and were able to show that psychological safety was the foundation for all high-performing teams in Google. That is to say that all high-performing teams possess high degrees of psychological safety and low-performing teams possessed low levels of psychological safety. There’s a clear correlation.’’   12:34 Psychologically safe workplaces are more inclusive Tom said if we don’t practice inclusion, we will only have diversity on paper, not in reality.  ‘’…we talk a lot about diversity on teams, diversity in organizations, but fundamentally, if we're not practicing, and psychological safety is about the practice of inclusion, if we're not practicing inclusion, then we might have diversity on paper, but we won't in reality. We might have a very diverse group of people who don't feel safe to suggest their ideas or ask for help or ask questions, and that's not true diversity. So I guess that's what I really mean by inclusion, and that's where we're coming from. …..And I should say as well, because that also leans directly into high-performing teams, right? Because a high-performing team is one where we surface all the best ideas or we surface all the ideas, and the best ones come to the surface and get made into reality. And it's also the ones where people are safe to challenge some ideas or some ways of working if we think there's a problem with it or there's a risk to it. And of course, it's through those multitudes of diverse backgrounds and diverse experiences that we can surface that range of ideas and that range of challenges.’’   15:01 The unique challenges of psychological safety in healthcare Tom said the potential for serious consequences makes healthcare unique.  ‘’ It is certainly unique. In healthcare, we're dealing with grave consequences of failure, patient safety, patient outcomes, life and death situations where, as we were saying earlier, where if an anesthetist or a nurse in an operating theater it doesn't feel safe to point out, "You've left something in the patient or that's the wrong leg", or there's some other concern, then that's going to result in a very bad outcome, which is not necessarily the case in other industries. There are also aspects of sheer demand on people's time, the cognitive load and the physical load and the time burden on people working in healthcare is great, is incredibly high. And what may be even more challenging is that it can be unpredictably high and low. So we go through periods where it's incredibly busy and then maybe less busy later on. We don't necessarily have the luxury as other industries do. We don't necessarily have the luxury of managing how much work we're doing at any one time. And that can result in, as we often see, the patient outcomes are worse when those peaks of workload are at the highest because people are more likely to miss an important step in a process or misread a signal or misread an alarm.’’   18:23 Three keys to creating psychologically safe organizations Tom explained why behaviors, practices and leadership involvement are vital to create safe organizations.  ‘’ This is the big question, isn't it? So I'm not even sure where to start because there's a few things we'd like to suggest, and we work with organizations to do. First of all is that for the people at the sharp end, for the people at the sharp end of work, we need to talk about behaviors and practices. And we like to separate behaviors and practices. So practices might be things like after-action reviews, debriefs, Schwartz Rounds and things like that. Things that you can name and begin doing and get better at creating feedback loops and things like that to continuously improve. And those practices and those rituals and those ceremonies, and whether creating team charters and social contracts, they can help foster and build psychological safety within our teams, within our organizations. There's also behaviors, and behaviors are the way we do things, those little interactions and the way we communicate, the way we work with each other. And that might mean improving the way we listen. So active listening. It might be non-violent communication. It might mean framing work in different ways. It might mean checking your body language and the way we communicate. All those sorts of micro dynamics and the way we interact with other people. So we can work on behaviors, we can work on practices, and we can do that at the sharp end of work. What we also need to do is speak to leadership and convince leadership that this is something worth doing. This is something worth putting effort into. And that means speaking the language of leadership. That means speaking to their desires, their goals, their objectives, and their fears as well. And in healthcare, the fears are patient deaths and poor patient outcomes and whatever that means for the organization.’’   22:49 The Andon Cord principle Tom said thanking people for pulling the Andon cord is the most important part of the process.  ‘’The Andon cord is a principle, a part of the Toyota production system that... is a mechanism for someone who's working on the production line to pull a cord or pull a metaphorical cord nowadays and request help. Stop the line, stop work, request help, because either there's a problem to address, which indicates some upstream fault or some process issue or something else going wrong, or there's simply an opportunity for improvement that they need help with implementing and it's important to address right now. And there are a number of amazing things about the Andon cord. One is that whenever it gets pulled, people are thanked for doing so. And that's probably the most important part of the whole thing, because ….this takes away that interpersonal risk. Well, it doesn't take it away completely, but it mitigates it. So it means that it's a praiseworthy thing to do, and it gets embedded within the culture. And so every time you pull the cord, something gets improved, even if actually it was a false alarm. Because even if there was a false alarm, you're learning about the signals that created that false alarm. What do we need to do to make sure that it’s not going to happen again? And it's fantastic. The Andon cord is such a powerful idea that almost every organization we work with adopts the Andon cord in some way, whether it's language or an actual tool or a real physical thing.’’   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Tom Geraghty on LinkedIn Check out VIE Healthcare and SpendMend    You’ll also hear:    Tom’s personal experience of dyspraxia and his career history: ‘’….at some point during that process, maybe about a decade ago, I came across the term psychological safety. And for me, that was the light bulb moment.’’ How psychological safety has finally come of age: ‘’You’ve got this conflux of factors coming together with a topic, a field, a phenomenon that is of its time and the need for the growing recognition for psychological safety in … healthcare, in technology, in manufacturing, in aviation, and everywhere else.’’ A team or group is only as safe as the least safe person in the group: ‘’In a group of 10 people, you might have… eight people who feel really psychologically safe …. but two people in the group who don't for whatever reason…that group is not what we would call a psychologically safe group.’’ Everything is an experiment and a learning opportunity: ‘’The outcome of work should be learning how to do it better next time. And if we reframe work like that, we're almost taking failure off the table because the only experiment that fails is the one we didn't learn from.’’   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.
28:36 20/12/2023
The Power of the Caregiver-Patient Relationship | E. 93
American healthcare outcomes are falling. Can a collective response bring much-needed change? Authors of Ripple of Change, Todd Otten, MD, and patient Joshua Judy explain why it’s possible to Jim Cagliostro.   Episode Introduction  In a wide-ranging conversation, Todd and Joshua share their transformative patient-doctor journey, the most important component of the quadruple aim, and why healthcare providers need to ‘’put the keyboard down.’’ They also emphasize that telehealth isn’t a ‘’one size fits all’’ solution, explain that it’s OK to be vulnerable, and encourage doctors to offer hope, even when they don’t have the answer.    Show Topics   We sorely need to talk about American healthcare Four components of the quadruple aim Three stories about patient-provider relationships The need for leadership at the highest level How to rebuild patient trust The positive impact of telemedicine     01:59 We sorely need to talk about American healthcare  Josh outlined the motivation behind Ripple of Change.  ‘’For us, I would say it was really born out of a mutual frustration with our experiences. First, as individuals, me as a patient and Todd as, my family physician. And over time, you know, as this project got off the ground, we realized, there's really a collective frustration. And we realized our feeling was that not only did we deserve better, but everyone that's a participant in the health care space, whether it's a nurse, a staff, or all the other patients out there. And there's just too many not getting quality care that they deserve in a way that they can afford. People are feeling powerless, so we wanted to give that a voice, as well as tell our story and help others. It takes months to see your family doctor, and that shouldn't be the case.’’    04:21 Four components of the quadruple aim Todd explained why the fourth component of the quadruple aim matters.  ‘’I was an early adopter of that vernacular probably, I guess, 7 or 8 years ago, almost right when it came out from Dr Sinski and Dr Bodenheimer. But it just seemed brilliant to me. You want the best for the patient experience. You want quality care. You want lower or reasonable costs. But that 4th component is so important, that’s provider well-being. Over the years, Joshua saw me at my best, And he saw me at my worst. And, you know, that's brought out in the book, and we don't want patients getting the worst from their doctors or their providers or their clinicians. But we also felt like that it needed to be not just my idea or Joshua's idea, but anybody can take these simple principles and run with them and make them their own. Change the verbiage a little bit. Right? Like, some people don't like the word provider. Fine. So be it. Change the word. Use clinician. Use health care associate. Use human being.’’   07:11 3 stories about patient-provider relationships Josh said patients appreciate uninterrupted listening from their healthcare provider.  ‘’Story number 1 handles my hormone treatments. It's through telemedicine. But, he approaches each visit the same way. He goes over the blood results, and then he turns to me and he says, the floor is yours. And he never cuts me off or tries to subordinate. And even if the treatment plan doesn't end up changing during the visit, I already feel better. So it's interesting because it's a cash practice without the obstacle of insurance. Right? So that that gives a totally different dynamic. And so the time is there. And it’s not a competition to win a debate. It's really a competition to heal. And that's story number 2. I recall times my wife would come home after a hard day at work, and, she'd start telling me of her challenges from the day and only for me to immediately pounce and try to problem solve her issues. But that's not what she was looking for. She just wanted me not to sideline her and prove how smart I was at fixing these things. Purely listening proved enough for her. And number 3 is about an endocrinologist I saw before the doctor I described in story number 1, and he practiced with taking insurance. Each visit started the same way there. Most of the 20 minute visits were his retelling of the anatomy of the pituitary gland and how it sits in the head, so it was a competition for time. Each story shows the same thing. People simply appreciate that uninterrupted listening.’’   10:46 The need for leadership at the highest level Todd said change is possible with a culture shift.  ‘’And it I think the good thing, though, is I think it's possible. There are a lot of examples out there of good things happening, but the culture has to shift that way. People have to buy in. There needs to be the right type of leadership at the highest levels. Unfortunately, Joshua got to experience some of this in the most recent office I worked in where we called it the office utopia. There were all those pressures there and there were the time tranches too. But it wasn't the same, and we didn't treat it that way. And we didn't treat it like people were widgets going through an assembly line.’’   11:55 How to rebuild patient trust Todd reinforced the need for healthcare providers to listen to their patients.  ‘’I would echo what Joshua said in terms of listening. Frankly put your keyboard down, look the person in the eye, shut up, and listen. Don't have preconceived notions about what the diagnosis is because you might be wrong if you've already made it in 15 to 20 seconds. There might be some nugget of detail in there that is invaluable. I learned quickly on in my career that if you asked a couple questions and just sat there and listened to the person in front of you, they would usually tell you what the diagnosis this was. That would be my number one piece of advice. Joshua's case was very complicated…. near the end of our time together as physician and patient, the majority of what I did was listening, counseling and alternative methods. We wrote a book together, and that was one of the treatment protocols, and we're both better off for it.’’   19:11 The positive impact of telemedicine Josh said telemedicine isn’t ‘’one size fits all’’ but a helpful tool in patient care.  ‘’My wife who has epilepsy, she's actually never met her current neurologist, she sees her through telemedicine, and it works really well. They’ve been able to establish a great rapport and they end up talking about the book sometimes. It's just been a really great thing. You can’t really approach it with one size fits all. It's another tool on the tool bag. People should embrace it if they feel comfortable. I think things are moving in that direction. You know, so much of Ripple Change is not about leaving people behind. It's kind of about meeting them where they're at. Some folks are tech savvy, some aren't. But I see it as an overall positive thing.’’     Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Dr Todd R Otten on LinkedIn Connect with Joshua J Judy on LinkedIn Check out VIE Healthcare and SpendMend    You’ll also hear:    Why driving change in healthcare needs a collective voice to succeed. ‘’It has to be a large number of individuals to break down those silos. Ultimately, we're probably talking about pretty significant policy change.’’ How capitalism has failed the American healthcare consumer: ‘’The mantra of profits over people has condensed the visits and put the priorities in all the wrong places. How do you get a good experience when you're afforded literally 7 or 8 minutes to go in and talk to somebody? … It has to change.’’ It’s OK for healthcare providers to say ‘’I don’t know’’: ‘’If you don't have the answer… you can offer some hope, or at least try and get somebody to the right direction.’’ The benefits of a strong doctor-patient relationship: ‘’If you do it right first time you might avoid those repeat visits and all those referrals that increase cost…. and with that good relationship you share in the treatment plan.’’ Why it’s OK to be vulnerable as a patient: ‘’It’s okay to fall down and be vulnerable, but it's what you do to get back up that matters.’’   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.
25:57 13/12/2023
End of Life Care | E. 92
End of life care is a topic rarely discussed in healthcare. In a sensitive and candid conversation, critical care nurse Seung Eli Oh, RN, MSN, CCRN, explores what it means to die well, with Jim Cagliostro.    Episode Introduction  Seung explores the need for more medical training on end of life care, and why quality of life should be considered in patient treatment decisions. He also encourages all families and patients to have timely conversations about their wishes, discusses the importance of dignity in death, and welcomes the return of spiritual care for terminally ill patients.  Show Topics   The current state of end of life care in America A gap in understanding between doctors and patients Enabling meaningful conversations around quality of life Dignity in death and dying well Spiritual care and the end of life journey Serving as a model of leadership      4:04 The current state of end of life care in America Seung said doctors require more training on end of life care conversations.  ‘’….there are some interesting books out there that really talk about how health care in the modern age has become more and more secular. So it’s gone away from kind of the clergymen who used to have this conversation of end of life. Sure. You know, your primary doctor was probably the only doctor in your village who came and came to your home. So these conversations we’re having in your house. But now it’s all happening in the hospital. And it’s happening away from faith communities. So it’s much more secular now. And it’s all done by doctors, which there really isn’t that much training, to be honest. Most doctors that I talk to tell me pretty honestly that there really is no training in med school, if at all. You might get 1 class, you know, at most about palliative care, goals of care conversation. And I see that pretty realistically on the floor when we do have the situation when patients are dying and there are goals of care conversations about changing code status. A lot of these residents have no idea how to handle these conversations, and they kind of freeze up, and they’re not giving the patients really enough data. I’ve seen, like, the shifts towards palliative care. I think that’s really good. I think there’s more of that happening. But I don’t think it’s happening fast enough, and those conversations are still way behind. And I think the doctors are still very undertrained in terms of having goals of care conversation because it really is an art more than the science.’’   06:38 A gap in understanding between doctors and patients Seung said doctors must have honest conversations with families around patient survival.  ‘’But I think we also have a cultural issue here in America….. American medicine is reluctant to be paternalistic. They really don’t want to tell patients and their family how things should be done. They try to just give them data, and then the family gets to decide. But sometimes that doesn't always work. We live in the age of Google, and every patient and their families think they can Google everything and find out the information. But I find that even with patients who are highly educated, that when it comes to medical decisions, it's very difficult. And when it comes to their family, it's even more difficult. There are many more emotions that come into play. And I think a typical example might be a family member who's an engineer. If the doctor were to tell them you have 10% chance of survival, he sees the 10% much differently than the medical personnel who sees 10% as well. That's basically an impossibility. But as someone who works with computers, he might actually think 10% is not so bad, so we should keep trying.’’    08:00 Enabling meaningful conversations around quality of life  Seung explained the difficulty of discussing quality of life with families and patients.  ‘’… I think a lot of conversations are happening in less than probably 5 minutes, and there's not enough time. And sometimes there's a really good family meeting, and we do have good conversations, and there is a full discussion. But a lot of times in emergency, sometimes it's a 5 minute conversation, and patients just want everything done. The family just wants everything done because they feel guilty. They want everything for their family. Without a full understanding of what does this mean for quality of life? What does it mean how this patient will die? And I think I've had one really good conversation where I try to tell the patient, you know, if you were to be intubated and go to ICU, this might mean that you never wake up. This might be a final time with your family. Versus if you were to go comfort care, you might have the last few hours with your family. You might be able to converse with them and tell them what's on your mind. I think those things are really meaningful in life that are not always talked about during, goals and care conversations.’’   11:10 Dignity in death and dying well  Seung explained the difficulties in having timely conversations around death.  ‘’…Ideally, a patient would be surrounded by their loved ones, their family members, their grandchildren, just all around the bed and just holding their hands, Sometimes singing together, I've seen that. And I think that's such a meaningful way to spend your last breath and having your loved ones hold your hand. Now in the code blue situation when you're really sick, that's not always going happen. We try to get family in the room, but it's often a traumatic experience. I think that's not always the way we want to go. We really have to be realistic and say, if our chance of survival isn't that high, how is it that I want to go? Do I envision me going in the ICU bed with a nurse putting lines at me… much unnecessary suffering are we causing? You know, we promise to do no harm in medicine in nursing as well. ….There's a lot of futility, when these patients are so sick.’’   13:57 Spiritual care in the end of life journey Seung said he has seen a rise in the need for spiritual support in terminally ill patients.  ‘’I think spiritual care is a huge part of that. I think medicine and science has moved away from the spiritual aspect of things. And now we're starting to see a little bit of that come back. Even though it's not as religious now, there's still a movement towards people who want a spiritual atmosphere,…. when we took the spiritual out of the goals of care conversation, end of life conversations, I think that's made it very sterile or very secular. And now that some of the spiritual things are coming back into conversation, that makes it easier for families to talk about. …. How would they want to be remembered? How would they want to spend the last hour together with their family members? Those are really good things to think about and talk about it. ….that's really important and helpful.’’   18:18 Serving as a model of leadership  Seung said a focus on serving others helps to enhance patient care.  ‘’… the best leaders I've seen in health care are the ones who really model servant leadership. I've had many managers who their description of their job was to really serve the team, serve other nurses, so that they can better provide care for their patients. I thought it was really empowering to say, you know, I'm going to serve the team rather than just be the boss. I think that's something I always think about as just being a leader and even outside of my job. How can I serve and do what is best for the other people? …that's such a great example of leadership.’’     Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Seung Eli Oh on LinkedIn Check out VIE Healthcare and SpendMend      You’ll also hear:    Seung’s career history and experience as a rapid response nurse: ‘’… most of my nursing career has been critical care, rapid response. … you see a pattern of just the way we handle goals of care conversations and end of life care.’’ Healthcare providers must be capable of approaching end of life conversations more appropriately. ‘’… it’s almost like we've compartmentalized that to say, oh, well, that's .. an end of life issue. We're going to pass you on to the palliative care team…but death is something that every family has to deal with at some point.’’ The need to be honest with patients and families: ‘’I think often doctors are too reluctant to tell (families) like it is and really paint an honest picture of what the chances are. …I do a lot of CPR with my job, but CPR is only effective 10% of the time.’’ Helping families prepare for end of life conversations at an early stage. ‘’…. that's a difficult conversation, but it's something I really encourage family members to have.’’   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.
20:10 08/11/2023
Creating Deeper Connections Through Telehealth | E. 91
Telehealth became an essential part of healthcare during the pandemic and is here to stay. Josh Klein shares his vision for its future, and the role of Emerest, with Jim Cagliostro.    Episode Introduction  Josh explains why telehealth is still stuck in 2020, how technology can strip the humanity from healthcare, and why the missing element in telehealth today is social determinants of health. He also explains how Emerest is going above and beyond virtual communities to make real patient connections, and why true leadership is always allowing others to shine.    Show Topics   Leading by example Poorly applied technology can strip the humanity from healthcare Telehealth is stuck in 2020 Digging into the social determinants of health Building virtual patient communities Creating an oasis of caregivers Leadership is letting other people shine     07:59 Leading by example  Josh explained how volunteering as a paramedic inspires his daily work.  ‘’It helps me in so many different ways. As leadership in general, the role of an actual paramedic is truly when there's an emergency, there's usually a pyramid of system where if it's not such an acute emergency, an EMT can be doing this stuff. If it’s a trauma, somebody hurts themselves, they don't need help. But if it's a true emergency where the person's life's on the line, if there is no leadership, the emergency will go south. It will go sour. So in order for the call to be successful, the emergency to go well, to have the outcomes that's desired to save someone's life, if they need to get to a hospital alive. There needs to be a lot of leadership in that role and taking control of a chaotic situation more times than others. And that's taught me enormous, enormous values and learning from other paramedics. You know, what I learned in the health care space. I've been blessed to do this for a very long time, more than I'd like to admit already by now. Different people that have different backgrounds, different capabilities. You know, this, volunteer organization has, you know, a few 100 paramedics and seeing how a paramedic that is a shop worker or a baker or a Forbes list guy or a finance guy, how they lead is learning. If you're constantly learning, learning their skills how to engage. So it gives me an enormous amount of learning experience and insight and being able to carry it over to what I do in the, in my workspace.’’   10:21 Poorly applied technology can strip the humanity from healthcare Josh said the focus has to be on the patients, not technology.  ‘’Well, first and foremost, thanks for picking that card because I couldn't agree with that one more. And I think it's just a trickle, then there's just a snowball effect how this happened. You know, technology, everybody wants a piece of it in a certain way, but it's more from the business side. Lots of leaders whether it's payers, hospital systems, frankly, or people that are in the health care space. The word technology just became, you know, a thrown around sexy word to say, let's apply technology, let's apply everything. And in my mind, it's driven sometimes, not by all, by certain needs or certain desires, not really wanting outcomes for the people that are receiving care. And I think the biggest fault to that is once they convince themselves that they applied technology, they automatically take a back seat and said, let the machine do it. And that's where you fall off. If you take off the eye of the prize that you want to treat somebody well. In our in our case, it's patients at home. Yeah. We can throw certain technologies. You can throw monitors and, you know, monitor their vitals. And the company is like, oh, I saved a couple of dollars. And that is not what health care is supposed to be. That that is just gonna further break the system by perhaps maybe saving money for certain people …’’   12:48 Telehealth is stuck in 2020 Josh explained why telehealth has not progressed since the pandemic.  ‘’(In 2020) … telehealth mushroomed … it was forced upon, frankly, lots of providers. And they relied on just that when COVID came. And there were millions of people that were in need of care and had no access to care simply from a logistical standpoint. You had, hundreds of thousands of patients millions of patients that needed for whether a doctor's visits how many doctor's visits were simply missed because, a, the doctor wasn't available. He was home hiding under a blanket… and the patients couldn't even access them. So there was definitely no question that the telehealth concept, of course, the reason why it mushroomed is, you know, necessity is the mother of all invention as they say. So there was a necessity to connect patients with whoever that is. So the telehealth, of course, made sense and there was a need. So, of course, today that the the simple concept where you can speak to your physician on camera, it was good in 2020 when COVID was there. It's still good today. It still needs a lot of work. It shouldn't be missing these elements, but 2020 really blew that up in a way. And lots of people stayed stuck in that 2020. They stayed stuck in, oh, I can give my patient an opportunity to speak to a doctor, I don't like to speak ill of the way it's done. But so many of these programs are just designed to follow billing codes and trying to make business out of it. I'm an entrepreneur, and I'm all for doing good business and creating companies that, create jobs. But the second you lose focus on the bigger picture, we will see trends with the telehealth with certain entities that have tried. And they might have had amazing intentions. No questions. But they're losing sight of lots of different areas.’’   20:12 Digging into the social determinants of health Josh explained the importance of truly understanding patient needs.  ‘’Are they really alone? How long have they been alone? Loneliness is such a broad word as well. Loneliness doesn't necessarily mean that they live alone. Some people are lonely when people are right there in their home. They just might be there. They're just people that are just you know, they like there's some people like to be alone, but it it's truly understanding really what are their needs. A lot of people, especially the elderly, they tend if they don't feel well automatically, besides their mood changes, they truly have whether it's anxiety, depression, and mental health problems. And if the assessment that we do is really get as much information as possible on that individual and put in things in place to address them. So, when we make that assessment, the same way we have a risk assessment on the clinical side of, you know, whether they need a lot of nursing. How much social interventions do they need? Do they need a social worker every day? If somebody has, true, for example, mental health problems, and lots of them sadly do, whether they've had it for all their life, or if it developed over time, or frankly, COVID did them in, so to speak. So is addressing them and helping with that and giving them really tools to have somebody to speak to. Besides that, we have a large social group program. We have social workers that speak to them. We have psychiatry and that truly understands their medications, understanding, managing their medications properly. Well, how many times we've had patients that when we took them on the clinical side, no. There's no mental health problems. Magically when we did the assessment, somehow, we found out, you know what? They can use something to help them.’’   25:23 Building virtual patient communities Josh explained how he used technology to build connections for vulnerable patients ‘’…. You know, people just like company. And, you know, the 1 on 1 concept is very, very good. But, if we're talking about home care patients that don't get the opportunity at the snap of a finger and just go out. …an elderly person (will) tell you they don't see many people 8 o'clock at night, a group of 75 year olds getting together for dinner. It just doesn't happen that often. You might see it here and there, you know, where they have a, a $30 free buffet once a month. But you're not gonna see it in a systemic way, and it's not that popular, frankly. So what we really believe was how can we take somebody that's ordinarily home alone, or even if they do have, make them belong to a group. …. and we made groups. …we derived it from artificial intelligence and machine learning, but not before we really did lots of research. Everybody had input. So what we call it a grouping model where the groups are up to between 6 to 10 elderly in a group. And we wanted to give that group legs and have, you know, the best potential for success. And so the nursing department had input as to how that group was created. The social workers had input, you know, where that specific individual can in which group they would fit. And then we use technology to mush it all and to gel it all together. And we still reviewed it as humans to see. So we have now dozens of groups where we have elderly people on our platform. They play games. They talk politics, news, current events, and we're seeing so much success on our platforms where these groups are, and it’s lots of times in the day. Some of them are up 5 o'clock in the morning already kibbutzing and schmoozing as a group at 5 AM.’’   38:53 Creating an oasis of caregivers Josh explained how Emerest encourages physical interaction and activity for its patients.  ‘’It's very unhealthy to have people just constantly staring at their screen. So besides programs that we do, that we engage with them with exercises, get your you know what out of your bed a little bit or out of your recliner there. You know, we do a lot of yoga exercises with our elderly through our platforms. But one of the things back to the grouping model, and that's the one thing that I promised myself and to the people that that helped me build this, is I don't want that to become that. That's not something that we wanted them to become telehealth potatoes. …. You know, I'm blessed to be the CEO of thousands of caregivers. So in every state and borough that we operate, we built an oasis for caregivers where they can go. And it's like a 5 star spa where they have manicures and pedicures and hair services for free for our home for our home health aids. So the thousands of home health aids that we have, they have access to that. …. So that's primarily on the weekends because caregivers work during the week. So what we're doing is taking these groups of elderly now that have been created, and we're having them come out and have lunch together.’’   41:36 Leadership is letting other people shine Josh emphasized the importance of learning from others and leading by example.  ‘’I learn every day from the people around me. And, leadership is letting other people shine. And, you know, to me, the word CEO, the e, has a lot of different meanings. It's emotional. It’s so many chief entertaining officers sometimes. And, yes, the number 1 is you have to lead by example. And a different CEO position in the finance world might be different meaning of leadership. In health care, you don't sell a commodity, but you sell care.  If you genuinely do not show the people that are helping you build these companies, you do not really have that same vision, ….. You first and foremost have to care for the people, for the people that are working with you, whether it's the CEO COOs, nurses, home health aids, you have to let them shine. There’s no such a thing as a bad idea. I've never ever dismissed an idea. I might have inside thought, yeah, I don't know. But not to let them feel that their voices are not heard, that's the worst thing. Everybody wants to feel that they add value in a certain way.’’   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Josh Klein on LinkedIn Check out VIE Healthcare and SpendMend    You’ll also hear:    Growing up in a healthcare community: Josh’s early life and career history: ‘’Mom started when I was very young, a nursing agency. And she staffed nursing homes and hospitals…. I grew up where nurses used to come and have dinner.’’ What’s really missing from telehealth: ‘’But the real thing that's missing in my mind, and that's where we really shine, is the social determinants of health (SDOH) and mental health. And that's where I really believe we're going to be an outlier because for some reason, people are just letting that fall by the wayside.’’ Building out support for SDOH: Managing the social and clinical needs of patients. ‘’The nursing team picks up certain things that they will call social work department. You know, the patient just mentioned something to me. I think you should have a conversation with that patient about it and vice versa.. ….my pride and joy is the social and mental health that we're building out. And we're doing lots of different very cool ideas and constantly advancing it.’’ How Emerest created a television studio to support the lonely and vulnerable: ‘’What would you want if you're elderly, home, bored, alone, not feeling so well? ….This is just, as they say, studio 1, we’re mid construction for other studios.’’     What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.
45:41 25/10/2023
Rebate Management in Healthcare | E. 90
Hospitals are under continued pressure to reduce costs and deliver better care. CoFounders of Rebate Insight, Tony Garcia and Jonas Langvad, explain the benefits of rebate management to Jim Cagliostro.    Episode Introduction    Tony & Jonas explain why 100% of rebates go straight to the bottom line, share the 3 Ms of rebate management, and highlight how Rebate Insight’s SaaS solution is increasing hospital rebates by 26% or more. They also explain how ‘’dark data’’ blurs visibility into rebate management and celebrate being part of SpendMend.    Show Topics   Rebate management should be a priority in healthcare Manual processes make it difficult to track rebates The 3 M’s of rebate management Dark data and the pain points of rebate management Benefits of Software-as-a-Service (SAAS) The value of SpendMend     02:29 Rebate management should be a priority in healthcare Tony said in times of financial pressure, rebates go straight to the bottom line to boost margins.  ‘’I think I'll start a little bit at the high level, to get to the 10,000-foot level for hospitals. The financial performance of a hospital is always important, and I think we've had a few interesting years in the past here, coming out of, first of all, covid introduced a lot of additional costs for hospitals, labor shortages, and product shortages for sure that spiked prices. Then after that, we've seen a great deal of inflation and products increasing dramatically in price, so that's really impacted hospitals in a big way. I think right now, just the financial situation, everyone's looking to see what can be done to reduce cost, stay competitive. When it comes to rebates, rebate management, it's historically been one of those areas that maybe hasn't been looked at that closely because it is a little bit of a complex area to manage. I think what ends up happening is when you think about, if hospitals are looking for areas to save money in, to reduce costs, they can have different initiatives. On the revenue side, if you end up increasing revenue by let's say a few million, only about 2% to 4% of that ends up going to the bottom line, because that's usually the margin of a hospital. It's very low-margin on the revenue side. However, if you're able to increase rebates on the cost side, 100% of that is going to go to the bottom line. You have a huge upside potential if you're able to manage rebates well and increase those rebates.’’   05:53 Manual processes make it difficult to track rebates Jonas explained the benefits of automation in rebate management.  ‘’I come with 25 years of healthcare experience. I've been a director at a health system in Southern California, and this is how this was all created. It was so difficult to track rebates, and the benefit of tracking them and knowing what is owed and what the vendor should be paying you and if you're going to meet your market share was so important and critical, but it was just too hard because the process has always been manual. Historically to this day, we've had many discussions with very large IDNs, some of the largest IDNs in the nation, and also on the lower end with smaller hospitals, and they all have the same issue. They're all using a manual process. They all have teams of staff that do different things, so it's always been difficult to track rebates. I think now, historically, we created this software that automates that process, where you're not having to go to a spreadsheet every other day, where it's giving you notifications in real time. You're always aware of what's going on in your contracts, where your market share, where your spend is, and just giving you a lot of insight into rebates and making sure that the vendors are paying you out, paying you on time, and also that you're meeting their commitment through the agreement as well. It really helps the materials team handle all that.’’   08:02 The 3 M’s of rebate management Tony explained the importance of monitoring, managing, and maximizing and how Rebate Insight helps hospitals to achieve all three.   ‘’Looking at this product and taking all the different information that you receive, we found that by monitoring, managing, and maximizing ... those are our three M's. Those really, if you were to see the demo or if you were to see the dashboard, it really kicks in, and you're able to ... under the whole monitoring is monitoring what your health system's doing. How are you handling every contract that goes into Rebate Insight, giving you at a high level all the information you need, and then going into the managing piece where it's more detailed specific to each agreement. Then going into the maximizing, where you're able to go in and if it is fifteen days, five days before your quarter ends or your annual commitment ends and you have to make a decision, you're able to do this all through the software, in real time, in a point-click SaaS product. You're able to effectively go into this product and make decisions or see where you currently stand, all in real time.’’   11:11 Dark data and the pain points of rebate management Tony said hospitals share many common pain points. ‘’Some of the common pain points are we don't know what is owed to us. We don't have any expertise and rebate insight. We work kind of siloed. We don't know what AP is receiving. Checks are going everywhere. We're receiving credit memos that people are not aware of. There's just a lot of that what I say is like dark data out there, and no visibility for the health system as a whole. One thing we found while we were creating this is how many people are involved and how many people should be in the process of rebate tracking that are not, just because you have someone like the director negotiating agreements, putting rebates in place, but you have, on the other side, AP that is receiving the checks, or maybe the vendors are bringing the checks to the director. Just a lot of mismanagement of also where checks are. A lot of times checks are lost, so there's nothing really that connects everybody. That's what's so great about Rebate Insight. It's all built in that platform where AP has a module, where directors can have access to that dashboard, and then the materials team has access as well.’’   13:56 4 Benefits of Software-as-a-Service (SAAS) Jonas said Rebate Insight can help to support renegotiating contract terms with suppliers.  ‘’Really, I think when we think about value is we think about it almost in different buckets, right? We think about I should say it goes under financial leakage, is you make sure you receive what you're owed. That's a big piece. Second is if you can speed up the actual payment, receive it earlier, then you can gain some value from having that cash on hand. Then third, what we think about is if you can maximize your existing agreements, you have opportunities at a given time throughout the year where you might be able to go to a higher tier because you're so close. You spend a little bit more money to get a bigger benefit. Then finally, when you have a tool like this ... and I think Tony can speak to this as well ... is you get that visibility into all your agreements. That enables you to just have discussion with suppliers and vendors and say, "Why don't we renegotiate our terms? Give me a little bit higher rebate," which when you can track it, that's a huge benefit for the health system and you're going to see that financial return.’’   19:22 The value of SpendMend Tony and Jonas agreed that being with SpendMend feels more like a partnership.   ‘’At first, there's always a little hesitation of selling your creation, right, but the value that SpendMend brings to the table with their 30 years experience in the health system, it has just been so great for at least speaking for myself, and I know Jonas will talk a little bit of this as well. I mean, when you really partner with ... and that's what it really feels like. It doesn't feel like, "Hey, you got bought out and that's it." No, it really feels like we partnered with SpendMend, and it just really opens up a lot of doors for us. Again, with that experience, being able to go to certain leaders in the organization and able to have a sales team, a marketing team, is huge. Those all have been great benefits, and super excited and really almost privileged to have that opportunity.’’   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Tony Garcia on LinkedIn Connect with Jonas Langvad on LinkedIn Check out VIE Healthcare and SpendMend    You’ll also hear:    Understanding rebates: ‘’For those not familiar with rebates, right, it's basically a supplier that offers you an incentive on a contract. If you buy X number of products, they'll give you let's say 5% back on a rebate. Usually there's some criteria tied to it, but that's sort of the starting point there.’’  The benefits of Rebate Insight’s SaaS tool: ‘’… we're seeing how systems that are using Rebate Insight increase their rebates by 26% or more by using the tool.’’ How Rebate Insight transforms rebate management: ‘’It’s subscription-based, cloud-based, which makes it very easy to sign up for, implement. There are no expensive servers …it pulls together all the data from different sources… It really gives you that real-time view of this is where you stand today. You can monitor all your rebates, all your contracts this way, all your compliance.‘’ Rebate Insight tracks trends and tiers for hospitals: ‘’Rebate Insight tracks your trends. You could go back and look at the quarter and say, "Wow, my trend for last quarter was tier two, but we're still signed on tier one. Oh, this quarter is tier two as well. The vendors don't tell you that. The vendors rarely come back and say, "Hey, you've been achieving tier two, go ahead and click on it because now your price is dropping 20%."   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.
22:41 18/10/2023
Good is the Enemy of Growth | E. 89
‘’Good is not the enemy of great, it’s the enemy of growth.’’ Sue Tetzlaff explains the transformational power of a strategy focused on greatness and the formula of leverage, to Jim Cagliostro.   Episode Introduction  Sue shares how creating a volunteer army transformed a struggling community hospital into a profitable, national award-winner, why the patient experience and the employee experience can’t be separated and reveals strategies that can move 20% in a patient satisfaction metric in 18 months. She also explains how leveraging greatness in people, service and growth creates a magnet for talent, and why hospitals can never declare victory in greatness.   Show Topics   A moment of realization in a Michigan hospital Good is the enemy of growth  Setting up a formula of leverage Creating a strategy for ‘’greatness’’ is not an easy fix The patient experience is tied to the employee experience Growth can happen when leaders ‘’get real’’   04:34 A moment of realization in a Michigan hospital  Sue said acknowledging that 75% of employees wouldn’t use their own healthcare organization triggered change.  ‘’I remember sitting in a room with the executive team and it was our strategic planning cycle. I had already been there 10 years through three-year strategic planning cycles. We're there at the table again and we're looking that these trends are just as ugly or worse than they were last time. We sat down to craft our strategy for the next three years, and we're looking at them, and one of the things jumped out like no other. It was all ugly, but one thing jumped out to me. 75% of our own employees would not use the healthcare organization that they worked at. And that really reflected of how the community was engaging or not with using their local healthcare services. And so put that in the pile of all the other data that was bad about patient satisfaction, safety, quality, profit, market share, out-migration, everything. When you look at that, all of a sudden, I remember looking up and I looked around at my peers and I said, "I am not going to be on the leadership team that loses this community's important asset. I did not come to this work to do that. And we have to figure it out. We can't just tweak our strategies this next time. We have to do something big and different. If we keep doing what we're doing, we're going to keep getting what we're getting and it is not going to be good. We could actually spiral to closure and lose this important community asset." So that led to me being volunteered, of course, to lead a team to figure this out because it was my moment …’’   15:10 Good is the enemy of growth  Sue explained how that realization helped to create the framework of achieving great results.  ‘’You know how Jim Collin says, "Good is the enemy of great." Well, good is the enemy of growth. And my explanation of that is these patterns that we saw. Starting with our very first organization, we saw it there. And sometimes it wasn't only until retrospect and that repeated pattern of looking back that you saw that good is the enemy of growth. So when we first packaged, how do we take this down the road to another hospital, we created a framework called the framework of achieving great results. And in the center we were creating great strategies, then creating ownership and alignment for those strategies to be successfully executed on. And then over time, we added then creating agility because I really believe that the agile and the enduring committed organizations are the one that's going to survive. You’ve got to be agile. You’ve got to be willing to change. You’ve got to be willing to improve. You’ve got to be willing to grow.’’   17:30 Setting up a formula of leverage  Sue said the secret to success is not just in balance, but in leverage for growth.  ‘’So this people, service, quality and growth at first, making sure we were balanced and we truly did have strategies under people, service and growth, as well as finance that we had them all. But then we realized that the magic was really not in just being balanced across there, but really setting up a formula of leverage there where if we invest, especially because we're in crisis there, in people, service and quality and our strategies there, if we invest more attention, energy, focus there and we nail that and move it from good to great, then growing actually just organically happens. Especially when you're a hospital and your community is right around you. You can say you're great all you want, but if it's not true, your community knows it. You can just have a billboard and run more ads, but guess what? You could add more services, but they're not going to come. Build it, they'll come. Okay, people. That is not the reality always, especially when your reputation is whatever you have now isn't good, why is something new going to be good too? Your community and those bad stories in people, service and quality, especially in small communities, those are loud and they're lasting, and you got to overcome that. And it's only through people, service and quality that you're going to overcome that. So the new formula under creating great strategies is people, service and quality, good to great, and then leverage that for growth, which then improves your finances. So it's not just in balance. It's in leverage.’’   24:45 Creating a strategy for ‘’greatness’’ is not an easy fix Sue explained that in the early stages, the focus is on people, service, and quality before growth.  ‘’……..when I work as a strategist with new organizations that have been fine or good for 20 years, and their market share shows it, and your revenue growth shows it or whatever, is I actually for the first three-year strategic plan I do with them, I put almost all of their emphasis on people, service and quality and tame down their growth plan. It's almost like an early investment of shore this up, move it from good to great, and then now the next cycle is truly a growth cycle. And now you can leverage all of that improvement that's been done, and now your growth efforts are easier, more successful. You're a magnet for talent. You're a magnet for patients. And so I stage it that way. So it's not a quick, easy fix. It never is. None of this is a quick, easy fix, but I'll do that a lot when I'm mapping out a strategy for an organization, is if they need to shore up day-to-day operations, people, service and quality, put your time, energy and focus there for three years. And I can tell you that it will have decades of lasting impact on everything, everything.’’   28:48 The patient experience is tied to the employee experience Sue said you can’t improve one in isolation as both are tied together.  ‘’And so that's where it started, and that really is people, service and quality. Employee experience, people, patient experience, and we truly, truly believe, Jim, that you cannot improve the patient experience, which is both about safe and satisfying care. It can't just be about service and friendliness and nice. It's important. It's part of compassion and caring, is to be civil and friendly and all of those things. But if you're just that and your quality and your safety sucks, I'm sorry, it's like lipstick on a pig or painting the shack. We really have to have substance behind that of true patient experience being safe and satisfying. But we believe that you can't, and we've over and over again shown this to be true, that you can't really improve the patient experience if at the same time in parallel, you're not improving the employee experience, that they're so tied together that you can't even separate them. People caring for people. Both of those things have to be working well. So those really fit under that people, service and quality pillar. So since so much of our emphasis of our work was definitely on those solutions that made us a magnet for talent, those solutions that made us a magnet for patients were really about improving the employee and patient experience, people, service, quality. That's where we realized that that was where the magic was and then leverage that for growth.’’   38:09 Growth can happen when leaders ‘’get real’’ Sue said understanding their exact position and trend can help healthcare leaders discern if they need external expertise.  ‘’So get real with yourself. Get real with yourself, and then get real with do you know how to execute on strategies for people, service and quality? Do you really know? Do you have the inside expertise? And if you don't, you need to either figure it out, which I can tell you, it took us six years to figure it out, three years to mastermind it, three years to test it. You can spend that time or you can find somebody that can help you. There are experts out there. That's what we do. I know there are others. There's other formulas, frameworks that can do this work too. But I think you just first have to assess and get real about where you are, and not just where you are right now but that trend. Are you trending up, down, all over the place, out of control and your quality is whatever? That's your sign that you have a problem. Maybe you have to own up to yourself that you don't have the fix. I had a CEO say to me the other day, Jim, he said, he goes, "Well, I think I want to try to fix it on my own first, and then if we fail, then I'll seek some outside help." And I said, "If your boiler broke right now and you didn't have heating or cooling for your patients or employees right now, would you as a CEO go down there and say I'll give it a try to fix it myself before I call in an expert?" He goes, "No." I'm like, "Well, how is people, service and quality any less important than heating your building?" So …my parting advice to frontline leaders is even if your organization truly, truly, truly isn't making this a priority, it can be yours.’’     Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Sue Tetzlaff on LinkedIn Check out VIE Healthcare and SpendMend      You’ll also hear:  Sue’s 20-year journey to Co-Founder, Chief Strategist & Executive Officer of Capstone Leadership Solutions, Inc: ‘’My original career goal, Jim, was to be a hospital CEO, and I was checking all those boxes. I became a registered nurse. I got a bachelor's degree in health information management. I got my master's degree in hospital administration. I got my fellowship and my board certification in American College. I got my first VP job in quality and then as a nursing officer and then as an operating officer.‘’   How ‘’creating a volunteer army’’ dramatically transformed a small community hospital: ‘’We went to over 900 (employees). We went from losing millions of dollars to making $11 million the three years after we started. Our patient satisfaction went from the bottom 25% of the country to the top. Some of our quality statistics were at 17% compliance. Now we were winning national awards …’’   Identifying common patterns to create a common solution: ‘’…it's data and it's opportunities and it's problems. But when you work with multiple organizations, especially all at the same time, doing the same thing, you start to see patterns….this is not just a unique opportunity or solution or problem in one place. … This is a common problem. Can we have a common solution? ‘’   The problem with ‘’good’’: ‘’…And so the human behavior around something that's good is I may or may not use it again. I may or may not talk positively about it in the community and I may or may not recommend it to others. And that could be even if it's poor. If it's good, average, it's a may or may not kind of attitude or decision for the buyer. But when something is great, it's their go-to place.’’   Why hospitals can never declare victory: ‘’…really John Kotter would say, "Don't declare victory too soon." But I would add never. You can never declare victory on this. You have to just start, keep going and it is the infinite game. There is no end. No matter how good you get, you have to keep getting better in people, service and quality. You cannot give up or you will go backwards.’’   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.
41:22 11/10/2023
GLP-1 Medications in Telehealth | E. 88
The use of telehealth soared during the pandemic and remains a vital tool in patient care. Justin Schreiber explains what makes LifeMD successful, and outlines his vision for GLP-1 medication to Jim Cagliostro.    Episode Introduction  Justin shares the lightbulb moment that led to a change in his focus, the three keys to LifeMD’s success, and how compliance and mentality can improve the patient experience. He also explains why he believes GLP-1 is a once-in-a-century life-changing drug, the power of AI to lower healthcare costs, and why hiring the right people ‘’makes magic happen.’’   Show Topics   Three key elements for success in telehealth  How technology affects the patient experience Marketing expertise raises the profile of telehealth Maintaining a ‘’patient-first’’ focus GLP-1 could be a once-in-a-century miracle drug The future of AI in healthcare Leadership tip: hire the right people   07:02 Three key elements for success in telehealth Justin explained what makes LifeMD stand out in a crowded market.  ‘’There are three big things that I think a direct to patient telehealth company needs to be successful. The first is amazing providers. LifeMD is one of the few telehealth companies that has an affiliated medical group of mostly full-time providers. So we've had to hire some 1099 providers that still work for us 20 or 30 hours a week. But the vast majority of the doctors and nurse practitioners that provide treatment to LifeMD's patients across all 50 states, this is their full-time job and they love it. They're super passionate about it. They work together, they train together. It results in an incredible patient experience. Most other telehealth companies out there are using an army of 1099 contractors. They're trying to make a couple bucks on the side. Oftentimes the incentives are to get off the call as quickly as possible. We have a team of doctors that really cares about building the brand and really cares about providing comprehensive care.’’   08:03 How technology affects the patient experience  Justin said tech is the second big piece in LifeMD’s success.  ‘’And then, I mean, the second big piece is tech. The technology behind what we do is really complex. I think this is probably the most underappreciated thing in LifeMD. We've had 50 to 100 engineers in the US and we have a dev team in Ukraine as well that have been working now on just our primary care platform for the last three years. We've put tens of millions of dollars into that. It's proven at scale. I mean, so we run a business where we have 750 to 1,000 new patients coming on the platform on any given day. We have thousands and thousands of patients that are on various subscription for different prescription products for our lifestyle telehealth business. It's just a super complex business, especially on the compliance side to comply across 50 different states. And so the technology is really important and that has a big impact on patient experience.’’   09:02 Marketing expertise raises the profile of telehealth Justin said performance marketing expertise enhances LifeMD’s success.  ‘’And then the third thing I would say is just this legacy-like performance marketing expertise. There have been a number of telehealth companies that have great technology and have probably really awesome medical groups, I'm sure not as good as LifeMD's. But, look, our ability to go out there and actually run an ad and get somebody through a flow and convert that prospect into a customer, it's really special. I mean, we spend $40 or $50 million a year on media, LifeMD on every channel imaginable. We do almost all of it internally. And I think that that ability to control our own destiny and actually go out there and build these businesses through direct marketing within telehealth is really special.’’   12:04 Maintaining a ‘’patient-first’’ focus Justin said compliance and ‘’mentality’’ lead to a great patient experience.  ‘’I think the first thing is compliance. It's making sure that you have the right compliance infrastructure in place at the top to ensure that everybody in the organization, from doctors to nurses, to medical assistants, to even all of the various patient care reps in our patient care center, making sure they're all doing the same thing. A lot of that just comes down to policies and procedures and audits and having a great compliance infrastructure in place, which I feel really good about what we have at LifeMD in that area. Secondly, I think it's just mentality, right? I mean, I think we spend a fortune on our medical group... It hurts. I mean, hiring full-time providers and doctors and nurse practitioners and all the licensing that goes into this. I mean, it's one of our biggest line items at LifeMD on the expense side. And there's not a week that goes by where people are like, "Hey, can't we do all this async? Why do patients need to actually see the doctor? Can't they just fill out a form and we treat them? We could do 50 times as much volume with the same resources. So I think it's just the mentality. For us, a great patient experience, I believe, and great care results in us building brand equity and it results in good retention.’’   16:11 GLP-1 could be a once-a-century miracle drug Justin said GLP-1 drugs are offering additional benefits to people with diabetes.  ‘’…most people out there in the medical and scientific world and in the financial world look at this class of drugs as what could potentially be a once a century miracle drug. The class of drugs is called GLP-1s or glucagon-like peptide 1 agonists. There's four kind of big drugs in this class right now that are approved by the FDA. Three of them are approved by the FDA for diabetes. There's Ozempic and Rybelsus, they're both semaglutides. Wegovy is also a semaglutide, which is approved for obesity by the FDA. And those three drugs are owned by Novo Nordisk. And then the fourth big one is Mounjaro, which has been approved. That's a drug manufactured by Eli Lilly that's been approved for type two diabetes. All of these have been approved for type two diabetes, most of them for quite some time, some as many as two decades. The drugs are well understood, the safety of these drugs is well understood. But, look, what they realized as they were giving these drugs to patients for type two diabetes is that in addition to helping to regulate blood sugar, people were losing crazy amounts of weight. The early ones, people were losing five to 10% of their body weight, then came along Ozempic and some of the other semaglutides, and people started to lose 15 to 20% of their body weight. And now Mounjaro, which is Lilly's drug, which will likely be approved for obesity this quarter, the fourth quarter this year, a lot of people in the studies were losing 30 to 40% of their body weight.……One of the other side effects of these drugs is that people that have other addictions, whether it be nicotine or alcohol or any other addictive behaviors, when they're on these drugs, they're finding it easy to give up some of their other addictions as well.’’   26:27 The future of AI in healthcare Justin said AI has the potential to lower the cost of healthcare over time.  ‘’Well, I think one of the best ways to maximize the effectiveness of virtual care offerings is through in-home care and in-home tools. Think about everything, all of the things now, and this is a whole area of healthcare that's exploding and it's going to continue to take off over the next five or 10 years. But if you think about all the tools we have just in an iPhone and certainly what can be connected to an iPhone now in the home to diagnose, I mean, look, now you can use your iPhone camera and take a picture of your face and within a second you can see your blood pressure. That's likely to be FDA approved this year. You now have pulse ox obviously on devices like your Apple Watch. I think all of your vitals are going to be easily accessible to a virtual care platform within the next couple of years, as long as... There obviously are going to be certain Americans that are going to be hesitant to share that information with anybody- If you're like me, and probably you, I'm going to be like, let's upload it to the cloud and analyze it for me every morning and certainly share it with my doctor. And then AI is going to be a big part of it. I mean, I think that AI will certainly lower the cost of healthcare over time. A lot of these common issues in primary care can probably be diagnosed and handled using AI down the road with some oversight obviously from a physician.’’   30:13 Leadership tip: hire the right people Justin said finding the right people makes the magic happen.  ‘’I mean, look, I never ran a big company or had many employees prior to LifeMD. I always liked having two or three employees at the most. But I think the one thing that I've learned through LifeMD, it's the most important thing a leader can do, is recruiting people that are awesome underneath him or her. And that's what, if I think back on my trajectory with LifeMD and how the company evolved, the biggest catalyst... Look, we had a really awesome co-founder too, which were incredible, but co-founders are entrepreneurs, right? And they get a business so far and typically businesses outgrow them, right? And so what I've seen is as we've built out the C team and gotten the business to a level where we could actually attract really high-quality leaders out of other companies to come in and actually grow that part of the business, whether it be finance or marketing or technology, I mean, these were the hires that not only in a crazy way positively impacted my quality of life and how well I slept…. My strategy has just been find amazing people that you can trust that work really hard, that don't have egos and that are kind of proven and you make a bet on them. And when you get a full team of those like I think we have right now at LifeMD, that's where I think the magic happens.’’     Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Justin Schreiber on LinkedIn Check out VIE Healthcare and SpendMend    You’ll also hear:    Justin’s ‘’light bulb’’ moment that ultimately led to LifeMD. ‘’… this whole telehealth thing and this idea of technology, virtual care, in-home healthcare … there is no bigger addressable market that I'll ever see in the rest of my life than this. Let's build a company and list it on the NASDAQ, raise a bunch of capital to do some awesome things. So, that's how we got to where we are today.’’   The crowded space of telehealth: ‘’… especially in the post-COVID years, during the pandemic, you had a crazy amount of venture capital flowing into startup telehealth companies. I'm sure there are hundreds and hundreds, if not 500 different types of telehealth companies out there that have been funded over the last five years.’’   How telehealth contributes to primary care: ‘’The big knock on telehealth is that it's not real comprehensive healthcare, and we put everything possible LifeMD to be the opposite of that….There's a real emphasis on wellness. I mean, there's a longitudinal relationship with the same doctor. All of these things contribute to comprehensive primary care.’’    LifeMD’s comprehensive weight loss offering: ‘’LifeMD is helping patients not only access these (GLP-1) drugs, but also there's a coaching element to what we do….trying to help them implement some lifestyle changes along with the drug.’’     What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.
33:08 04/10/2023
A New Nurse Model For Transformational Change | E. 87
American healthcare is at risk of collapse as one-fifth of nurses intend to leave the profession by 2027. Jennifer Thietz outlines her vision of a new model for nursing and healthcare to Jim Cagliostro.     Episode Introduction  Jennifer highlights the soaring post-pandemic levels of burnout and high turnover among nursing staff, why the four primary nursing models are no longer effective, and shares her vision of building on a one-to-five patient-nurse ratio. She also explains why rebuilding connections helps nurses and patients to thrive, why nurses need to unite and use their voice, and reminds us that all nurses are heroes.    Show Topics   US healthcare is in a state of crisis Nurses are the bridge between healthcare providers and patients Healthcare requires a new model of nursing  Building on a one-to-five nurse-patient ratio Healthcare comes down to human connection  All nurses are heroes     04:12 US healthcare is in a state of crisis  Jennifer said that nurses represent 50% of the workforce but almost one-fifth intend to leave.  ‘’….this is a news release in April this year, and it's from the National Council of State Boards of Nursing, and they gave some really scary facts. We know that over 100,000 nurses left during COVID. They're saying by 2027, 900,000, or almost one fifth of the 4.5 million nurses, intend to leave the workforce. So that's a really frightening stat. We know that 189,000 nurses under the age of 40 want to leave nursing by 2027, 50% of nurses report being emotionally drained and burnt out, and this is the worst burnout in nurses that we've ever seen. So we really are in a real crisis, and we are losing our nurses daily. And without nurses, considering that nurses are 50% of the workforce, and actually touch 90% of patients. So you can imagine, if we don't have nurses, we can't nurse. We can't work in healthcare as it currently is. And I believe there will be a collapse in healthcare if we don't make some changes now.’’   07:42 Nurses are the bridge between healthcare providers and patients.  Jennifer said 90% of hands-on care comes from nurses, who are essential to provide a safe and happy environment for patients.  ‘’Well, nurses are fundamental to healthcare. As I've just said, 90% of the hands-on care comes from nurses. We're a huge, huge percentage of the caregivers in healthcare. And if we as nurses can provide care in a safe and happy environment, we can turn healthcare around. We're the bridge between the physicians, between the other healthcare providers, we are the bridge with patients. We are the ones who are there 24 hours a day, 365 days a year. We are the ones who are speaking with the patient, spending up to eight or 12 hours a day with individual patients, so we really are the front-runners. We understand what's going on, and we are the ones who are hurting. Everybody in healthcare is paying a price, but I believe that nurses are paying the biggest price at this stage. And the reason is that they don't... Many of them do not have sufficient help in the units.’’   11:21 Healthcare requires a new model of nursing Jennifer said nurses are no longer able to provide care as they want to.  ‘’Now, obviously, we are in unprecedented times in healthcare with this hemorrhaging of nurses, with the costs that are associated with care at the moment. And having been on the floors and seen how nurses work, I think the main issue with many of the nurses who I've been speaking with and who I've worked with, is that they don't have sufficient time to nurse the way they would like to. And the reason I think is related in some way to cost cuttings, where organizations are losing staff in order to stay afloat. And what's happening is nurses are now literally wearing two hats. They are doing their nursing specific tasks, which as the acuity of patients goes up, become more and more complex, more and more difficult, and then they're also asked to do care, for example, handing out food trays, or finding patients who are lost, and transport has got a patient and they're supposed to go to Dr. Smith's office, but he's now lost somewhere and they're making calls, they're doing ordering, they're doing billing, they're doing bathroom breaks, all of this work, which is obviously essential, because that's how a hospital turns around, and that's how nursing care is provided, but I think if we had staff, auxiliary staff, to help the nurses, just to take that load off them so they have the time to do their nursing specific roles, I think that for me would be the way to go.’’   12:46 Building on a one-to-five nurse-patient ratio Jennifer explained how using the one-to-five nurse-patient ratio can transform patient care by combining the benefits of two models.  ‘’And so I've looked at nursing, and I've used the benefits of two models. The one is the individual approach where obviously the nurse is involved with the care of the patient, and then a team approach where multiple people are involved, but I've shortened it or honed in on a ratio if possible of one to five, which is what CMS actually recommends. They don't mandate it, obviously, but the CMS is recommending a ratio, patient nurse ratio, one to five, and then involving in that team a nurse assistant that just works with that RN. So you would have one nurse, you would have one nurse assistant, you would have five patients, and then you have two sets of eyes on those patients all day. You have the auxiliary tasks, like handing out food trays, et cetera, taken care of, and the nurse then can go ahead and fully concentrate on their nursing roles. And I would add to this, Jim, which I think is extremely important, is a ward secretary, or a ward clerk we call them, whereby they are at the nurses' station, and they allow the charge nurse time to leave the nurses' station because they're going to be doing the directing of patients, they're answering the phones, maybe the ordering of meals, et cetera, and then charge nurse will then have the opportunity to be on the floor with the nurses where she's really needed, or he's really needed. So that's what I see as the hybrid individual team approach…. this one to one to five would be in units like telemetry, med-surg, oncology, the specialty units, obviously our ICUs, our step-downs, et cetera, have a totally different way of working.‘’   20:31 Healthcare comes down to human connection  Jennifer said the crisis in nursing is affected by the break in connection between patients and nurses, and between colleagues.  ‘’….I think nursing and healthcare in general boils down to the connection we have with our patients and with each other, with our nurses. And our connection with patients, and I'm saying our, but I'm talking about specific nurses, there are other nurses who are working in wonderful work conditions who have the time. I spoke to a nurse last week who said, "Hey, I'm very happy. We have this incredible organization and I'm working in a great team. I have help." Absolutely. And this particular nurse has the nurse assistant with her. So there are many organizations who are doing it right. I don't want to give the wrong impression, but yes, I believe that the crisis in nursing now is happening due to the break in our connection with our patients and our nurses. With each other, colleagues. We need to have that human connection in order to thrive, in order to heal, in order to work to our best ability. And many of us are going into our workplaces every day, and we are given an assignment, and we look down and we see the tasks that we have, and we put our head down and we just plow through those tasks. And we don't have the time to necessarily sit with patients, with each other, to connect.’’   27:16 All nurses are heroes Jennifer said in some ways nursing is more difficult now than during Covid and encouraged all nurses to use their voices and speak.   ‘’… I think the most important thing that I'd like to share is my deep respect for nurses, and to really... I'm hoping to empower nurses who are sitting in jobs that are very, very, very challenging. I also worked during the COVID pandemic on the floor, and we as nurses were held up as heroes during COVID, and we were, and we are, and I think we remain those heroes. I think what nurses are doing now is maybe in some instances more difficult than during the COVID pandemic, because then we had the support of everybody. Now, each nurse that walks into a facility remains a hero because many of you are working very, very challenging conditions. And you are highly intelligent, highly skilled, highly motivated, your compassionate heart, you have a right to raise your voice and speak. And speak as much as you can and share with your leaders, if you have ideas on what can happen in your units to help your job, make your job easier, then go ahead and share that information. I think communication is vital. We need the connection. So keep connecting. Keep connecting with each other, pay it forward with each other, look after each other, look after your nursing managers, and your nursing leaders as well. And let's come together and change healthcare, because we are millions strong. We can do it. And we just need to get our voices out there.’’   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Jennifer Thietz on LinkedIn Check out VIE Healthcare and SpendMend    You’ll also hear:  From South Africa and a heart transplant first, to Mexico, via America. Jennifer’s 20 years of experience at the patient’s bedside. ‘’And I think for that reason, I can really speak to this topic today, because I've been there, I've worked with these nurses, I've been on the floor with patients, and I have a great understanding of what is happening in healthcare.’’   Why the nursing world as we know it is unsustainable: ‘’… I'm passionate about this situation as a long time nurse… And I'm hearing stories all the time about working conditions, which are extremely difficult.’’   Why the four primary nursing models are no longer effective for modern healthcare. ’’… these approaches are, as I say, World War II up to the 1980s. They're old. They are nursing approaches that have been around for a long time, and I don't think they speak to what is happening in healthcare at this point.’’   Offsetting the initial cost of a new model of healthcare against higher staff retention levels. ‘’In the long term, the cost savings would be huge. …. And I believe that then the patient satisfaction would go up, because they would have this interaction.’’   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.  
29:56 27/09/2023
Making a Ruckus for the Patient Experience | E. 86
The art of ruckus making means doing generous work and serving others. Denise Wiseman explains the motivation behind her passion for improving the patient experience to Jim Cagliostro.    Episode Introduction  Denise explains the importance of a positive attitude in ruckus making, why healthcare needs a new paradigm of CARE, and the importance of setting rather than meeting expectations. She also highlights the need to make a ruckus about HCAHPS, the critical role of Patient Family Advisory Councils, and reminds us that all leaders are human – and everyone is a leader.    Show Topics   Making a ruckus is doing generous work  Calling for a new paradigm in healthcare Opening up conversations around the patient experience We need to make a ruckus about HCAHPS Expanding connections outside of healthcare Leaders are human too (and all of us are leaders)   07:32 Making a ruckus is doing generous work  Denise explained how Seth Godin’s Akimbo program helped her to understand the definition of ‘’ruckus.’’  ‘’So when I was given that opportunity to redefine my career, I took time to reflect and consider on what the right next step was for my career and also for my life. And so I took a few courses from Seth Godin and his Akimbo program and I don't know if you know much about Seth, but he ends his videos and his trainings with saying, "Go make a ruckus." And when he says that what he means, and this is a quote from him, "When we show up to make a ruckus, we're doing generous work. Work on behalf of those we seek to serve." And then he says, "We need to dig in and do something that might not work." And so when he is talking about making a ruckus, he's talking about thinking outside the box, embracing the unknown, being courageous and with a positive attitude and that's everything you'll see from Seth. It's with a positive attitude, stepping out, giving it your all, testing, trying and doing something differently. And Jim, that is exactly what we need in healthcare. And so being a Ruckus Maker, to me, is identifying those things that are problematic in healthcare. We're all aware of them. If you're on LinkedIn or in other forms, you're hearing people talk, complain about the problems of healthcare, right?  And I say, let's identify it, that's fine, but let's then understand enough that we understand the root of the problem, what's really going on to cause what we're seeing and then let's do something about it. And so that's making a ruckus, right? That's doing something about it. Let's stop blaming others, let's stop waiting for somebody else to solve it and let's take action.’’   09:39 Calling for a new paradigm in healthcare Denise said a new paradigm of CARE would put the ability to take time to care back into the system.  ‘’So the second part of your question was my call for a new paradigm. And so you'll hear many people talk about the current situation in healthcare as broken and I'm one of those. And in many ways it is broken. Not everything. Not everything is broken, but we are a system in trouble. We have patients who are heavily burdened by many expectations of them, within healthcare. We have staff who are burdened by regulations, organizational policies and practices, by the current challenge of staffing, by the disconnect between those very highest in leadership and decision-making and what actually occurs in the moments of care delivery. Our current paradigm has healthcare that is not accessible to all. Our current paradigm refuses care or at least to pay for care for far too many or inadequately pays and leaves thousands financially devastated for seeking life-saving care. We have healthcare that being delivered on the backs of nurses and clinicians. They are beautifully heart-centered people for the most part and they're striving to do their very best. And when we talk about moral injury, it's true injury, they're suffering. So a new paradigm would be the definition of care and that's all CAPS, CARE. I'm talking about an experience of healthcare where there's trusted relationships between providers and patients, the patient is known by the provider, the gaps in care are eliminated, misdiagnoses and medical errors are greatly reduced if not eliminated. The new paradigm puts care, the ability to take time to care, back in healthcare. Or as my good friend Tom Dahlberg would say, "It includes love and the relationship of all connected with healthcare."   14:03 Opening up conversations around the patient experience    Denise said the patient experience starts at the first moment of engagement.  ‘’….But here's the problem, there's a bigger issue with experience. Oh, so here we go. I should be able to schedule an appointment with my physician within days, maybe weeks of needing one. But in my most recent experience, I had to wait five months to schedule an appointment with a provider. Well, that's a bad experience from the moment I've engaged with your organization. And if I'm going to your ED and I have a two hour or more wait in the waiting room before any treatment has begun, that's experience of care. If I then have questions about whether or not I can trust the care that was given to me for whatever reason, perhaps a misdiagnosis, medical error or just a simple lack of or miscommunication, that's experience of care. And after all of that, I receive a bill for care that I can't pay for or will cause me extreme financial hardship, that is experience of care. And we are completely ignoring that with our conversations on our efforts for the improvement of patient experience.’’   18:21 We need to make a ruckus about HCAHPS Denise said progress in the patient experience has been minimal.  ‘’We've not improved experience, not really. The nationally publicly reported data reflects that in those first few years, we did make improvements and that's because at that time there was concern about the money, the incentives that were attached to the results and there was some fuel behind that movement. And in part I think some of it, that improvement, is attributed to Studer Group. There was a lot of effort being done. But in the last decade, I pulled the numbers just recently and I put a thing out on LinkedIn about this. In the last decade, other than the most recent declines in HCAHPS because of COVID, our national data shows we're flat, we've made minimal, if any, like a one point shift improvement across the different components of the survey….And yet we spend hundreds of millions of dollars annually to the industry of patient experience and we've seen little value. In fact, I would actually argue that we're causing damage. So when we look at the survey, I don't have a huge problem with questions on the survey. So HCAHPS, we can look at, but there are actually over 20 CAHPS surveys and more are being developed and there are good reasons behind the questions they select. So communication with nurses and doctors is critical for our patient's safety. We have to be able to understand what we need to do to take care of ourselves. We also need to be able to express how the treatments are making us feel or any other communication.’’   25:47 Expanding connections outside of healthcare Denise said band-aid solutions arise when we don’t listen to other perspectives.  ‘’… When we only ever hear from the same people, people with our same experiences, when we only experience the same experiences and when our knowledge is only deep, and deep is good, but it's not also wide, there's much that we do not know and our perception is narrow, it does not mean that our perception is wrong, but it's incomplete. And so when nurses only ever talk with other nurses, physicians with other physician, pharmacists with other pharmacists inside healthcare only willing to talk or listen to others from inside healthcare. And this one's really important in my opinion, when those who have positional titles or are considered thought leaders within their field are invited to the conversations or to make decisions, they're the only ones there. We're hearing only from the perspective of that group. We are then only working to solve our perspective of the problem. And this is what leads to band-aid solutions and gaps that we can't bridge. So I think it's absolutely critical for us to have a highly diverse, integrated and inclusive approach.’’   36:13 Leaders are human too (and all of us are leaders)  Denise shared her leadership tips and emphasized the need for grace and understanding.  ‘’…in those positions, they're also under a lot of stress, they are triggered. And so I think the most important thing that I have learned working across our country and meeting with many different leaders is that leaders are humans. They are. I believe the majority of our leaders in healthcare, at whatever level they are, they truly come to work each day wanting to do the very best. Often they're not positioned to do their very best and they're struggling. And so when we talk about healthcare leaders, it's an area where we place a lot of blame. I see too much of that where we blame the leaders for the current situation in healthcare. And I think instead we need to seek to understand, we need to understand the very difficult positions they're in and why they are acting the way they are and making the decisions they are rather than just placing judgment on them. We need to be able to extend a hand to help and we need to be able to give some grace, if, when a leader makes a mistake because they will, we need to be able to give them grace and to let them correct. And then I think the other thing is each and every one of us, no matter what our position is, are leaders. And so how can we consider our own way of acting, mentoring, guidance, and leading in order to role model it to those around us, to those above us, et cetera. So instead of blaming and saying, well, they're acting that way, I don't have to be any better. I think each and every one of us owns our own actions and our own leadership in the space that we reside within.’’   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Denise Wiseman on LinkedIn Check out VIE Healthcare and SpendMend    You’ll also hear:  From dietician to Chief Ruckus Maker: Denise’s career history and lessons learned along the way. ’’What I've learned the hard way is that for-profit organizations are typically, for the most part, for profit before all else’’. How an Achilles injury led to a life changing patient experience.  The importance of setting patient expectations:  ‘’So that's a key word there that we're setting instead of meeting, and this is the psychology of experience. For example, a hospital is going to be noisier than your home ... .And so there's an element that talks about how do we set our patients up for that expectation, to ensure that they understand what we mean by the question on an HCAHPS survey about quiet at night. ‘’ Why HCAHPS surveys still have too many gaps: ‘’… huge demographic populations are underrepresented in the responses, but as I hinted at earlier, the surveys have many gaps. They're not capturing critical components of experience, they're not elevating systemic issues from our national healthcare system.’’ The critical role of PFACS (Patient Family Advisory Councils) ‘’…our PFACs are critically important, underutilized, under-supported. We ask people to volunteer their time when really they need to be a partner at the table with us and perhaps be paid in some method for their contribution.’’   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.  
39:17 20/09/2023
Reimagining our Approach to the Mental Health Crisis | E. 85
WARNING: This episode contains discussions on sensitive mental health topics that include depression, anxiety, and suicide among youth.   Children aged 2-5 have the same rate of impairing mental health disorders as older children and adults. Dr Helen Eggar explains the work of Little Otter in addressing this growing crisis with Jim Cagliostro.    Episode Introduction  Helen explains Little Otter’s approach to mental healthcare for children, why mental health treatment hasn’t improved in ten years, and why it’s hard being a parent in America. She also describes how tantrums can be a ‘’mental health fever’’, emphasizes the need for a family focus in mental healthcare, and explains how telehealth provides access to care when 71% of counties don’t have a child psychiatrist.  Show Topics   Mental health has deteriorated since the pandemic 50% of mental health disorders start before the age of 14 Acknowledge the distressing impact of the mental health crisis A family focus improves mental health outcomes Tantrums aren’t just behavioral issues  The vital role of telemedicine in childhood mental health High quality work always wins out      10:25 Mental health has deteriorated since the pandemic Helen explained how a mental health crisis impacts the whole family.  ‘’What I say about the child mental health crisis is that we were in a child mental health crisis before the pandemic, but it was made much worse by the pandemic and the stress of the pandemic. We've seen significant elevation in particularly anxiety, but also depression in kids. But this report, this white paper that I referenced that we produced was based on over 11,000 families coming to seek care at Little Otter. And when families come, they complete what we call the child and family mental health checkup, which I created. And the idea is we do checkups for height and weight and other variables, but we don't have a way to check up on our child's mental health or our family's mental health, so when families come in, they complete this survey and they immediately get a report back. And the assessment looks at child mental health with separate developmentally appropriate sections for infants, toddlers, preschoolers, school age, and middle schoolers. Then we assess parent mental health, then we assess what we call family mental health, which is stress and the relationship between the parent and partner and the co-parenting relationship. That's what we see all together. We think at Little Otter that we don't just have a child mental health crisis, we have a parent mental health crisis. In our data, over half of the parents met clinical criteria for anxiety disorder and 1/3rd met criteria for depression.   13:27 50% of mental health disorders start before the age of 14  Helen said children are affected by their environment and we cannot silo family members in treatment.  ‘’Because children are impacted by their environment, by their relationships. Another example, of course, is with younger children whose parents are depressed. We know so much about postpartum depression and the impact it has on the mom. And it has a huge impact on the child's mental health. And it really impacts the quality of the parent-child relationship. Those are just two examples where we think to address this crisis where we have to innovate is not to silo the members of the family, carve them off and send them to different people, but there has to be an approach that's thinking at the family level. And I truly think that is our first big innovation at Little Otter. And the second one is to say young children are suffering at the same rates as teens. Teens, it's super important, absolutely critically important to meet the mental health needs of children. But again, if we're going to make a dent in this crisis, we have to start as early as possible. 50% of adult mental health disorders start before the age of 14, but we put most of our effort and our dollars into older children and into adults, and we're not focusing on where we can make a difference with early intervention and prevention. I'm so passionate about that, both where the industry should be focusing, but also educating parents so that they know the signs so they can advocate for what their children need and what they need.’’   15:30 Acknowledging the distressing impact of the mental health crisis Helen said a cohesive, connected and relationship-based approach is essential in mental health care.  ‘’I think one thing is that older children show up in emergency rooms with suicidal ideation at higher rates. And those are very expensive interventions, so I think that's one thing. Although the average age in our families, our kids we take care of for suicidal ideation is 10 years old. And we need to know that the second leading cause of death for children 10 to 14 is suicide. Again, it's not something that only happens to teenagers. I also think that it's somewhat more straightforward to provide mental health care to teenagers. And so at Little Otter, it's not just that we see young children, we hire therapists who are experts in early childhood mental health. It's its own area of specialization. And I think that many of the principles of our family mental health approach are embedded in the infant early childhood mental health field because you're never thinking about a three-year-old separate from the parents, you're with the child and with the parents. And so I personally think that approach should be applied across the lifespan. If you have a spouse who's depressed, it's impacting you in a huge way. And if you could be a part of that treatment to help understand and support your partner, I think treatments would be more effective. We're really trying to bring that more cohesive and connected and relationship-based approach to all of mental health.’’   20:24 A family focus improves mental health outcomes Helen said improving the mental health of children has a major impact of parental mental health too. ‘’It does. And I can tell you a very cool thing, which is in our outcome data, taking a cohort of over 200 kids who did treatment, 71% after 12 weeks went from the clinical to the nonclinical range. They had great impact. But we saw these were parents who we were not providing direct care for, we were just working with them in our Little Otter approach, that of the parents who had clinically significant anxiety at the start of their kids' treatment, 67% were no longer in the clinical range. And for parents who had clinically significant depression at the start of treatment, 71% were no longer in the clinical range. Even just providing mental health care for children with this family focus, with this engagement with the parents with the acknowledgement of the impact on the whole family, we had a major impact on parent mental health, so we got us two for the price of one. And because we very rigorously have a measurement-based approach and track outcomes using the checkup but also other measures, we're able to demonstrate that our care, even when it's just focusing on the child, impacts and improves the mental health of parents and the mental health of the whole family.’’   25:46 Tantrums aren’t just behavioral issues Helen explained that daily aggressive tantrums can indicate signs of a deeper problem.  ‘’But I'll give you a good example from my work that I think brings it home, because it can seem abstract. Think about temper tantrums. Kids two to five have temper tantrums. In fact, 75% of two and three year olds will have had at least one tantrum last week. And it goes down a bit at four and five. And the thing about that is that is developmentally appropriate because young children are learning the capacity to manage their emotions, their big feelings, to manage behaviors when they have big feelings. And they're not that good at it, and sometimes they just melt down. However, in my research I found that children who have tantrums nearly every day and who hit, bite, kick, or break something during a tantrum, those children are eight times more likely than children who don't do that to having an impairing mental health disorder. But here's the critical thing. People think about tantrums as a behavior problem. It's as much connected to emotions. Children who have these aggressive frequent tantrums are at much higher rates of having an anxiety disorder, of having depression as well as ADHD or a behavior problem. That's why I call daily aggressive tantrums a mental health fever. It's a generalized sign that something might not be right. It doesn't tell you what it is. You have to go and have an evaluation and look more deeply. But to me, that's a useful knowledge that we can share with parents, right?...To say, "Here it is. It's developmentally typical. But actually, this is not developmentally typical, and let's look a little bit more deeply at it."   32:31 The vital role of telemedicine in childhood mental health  Helen said telehealth is on the only way to provide wider access to mental healthcare for children.  ‘’I think it's a big question, can you do telemedicine in early childhood mental health? And the answer is yes. Again, science has shown that we can do that, and we're obviously doing it at Little Otter. And that is so important. We are experts in delivering telehealth to young children. You don't just plop a kid in front of a computer and expect them to talk like we're talking. You put the computer on the floor, we use the whiteboards, we have toys. We're very skilled at making it an engaging experience. But I think it's critical to understand that it is the only way we are going to address the access problem. United States, 71% of the counties in the United States do not have one child psychiatrist. There are states in the upper Midwest who have zero child psychiatrists. Yes, we have to encourage more people to go in the field, et cetera. But that is not going to be the solution. We have to be able to bring our skills to families where they are, meaning in their home. And this is critically important when you think about the need for specialization. Perhaps you're in an area that has some child mental health services but don't have specialized early childhood services. But at Little Otter, because we're 100% virtual, we can bring that expertise in. It could be early childhood mental health, but it also could be expertise in evidence-based treatment for obsessive compulsive disorder. It's not just the early childhood. The mental health care that works is evidence-based care, not just random care. And parents, I think, need to seek that high quality care.’’   38:12 High quality work always wins out  Helen said having a vision and being clear on your values and principles helps to succeed in the long-term.  ‘’…my experience has been, in the end, doing high quality work wins out. I'd say that was true in terms of the beginning of my scientific career when people doubted things. But if you do good science and you have the data to show it, you will be able to convince people. And so I think having just a very clear focus on what your values are and what are the key principles that you are focusing on I think really helps build for the longterm. And I think that's the other thing. I think when we create new things, it takes a long time. And so I think it's very important not just as a leader, but for inspiring the people who work with us to have five-year plans, to think through, okay, I want to be here. And how am I going to get there? And then to support people as they go through that. I think being able to have a vision for something that doesn't exist and then be able to translate that and share that with others is one of the most amazing experiences that I've had the privilege of seeing that when you do that collaboratively... All of science, all of clinical work, this is collaborative work; doesn't just come down to one person. But if you can create those collaborative teams with vision, you can make a huge difference. And I had that in my academic career, and now I'm having the privilege of having that experience in the digital health realm.’’   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Dr Helen Egger on LinkedIn Check out VIE Healthcare and SpendMend    You’ll also hear:    A passion for mental health in children from birth to 6 years: Helen explains the motivation to launch Little Otter: ‘’…the earlier that we intervene, the better the outcome is for the kids.’’ No change in a decade - the urgent need to address the mental health crisis: ‘’We have a white paper that we just produced called Breaking the Silence: Meeting the Mental Health Needs of Young Children that I wrote. And in it, I look at the rates from when I started my career in the early, mid-2000s to now, 50% of children who need mental health services, only 50% get mental health services. That number was the same in 2013 as it is in 2023.’’ Mental health’s elephant in the room: ‘’The elephant in the room is something that's the crisis of mental health as a whole, which is really how mental health is funded and the lack of parity of coverage for mental health care compared to coverage for other medical disorders.’’ Why it’s hard being a parent in America: ‘’We have not built a society that really focuses on maximizing the support for the youngest Americans or their parents so that …the typical parent is facing a lot of stresses that are going to impact their ability to support their children's mental health.’’ The impact of the first five years lasts a lifetime: ‘’We know from brain science is that the period from birth to age five is where the architecture of the brain is really set down… What children experience in their relationships and their environments and what challenges they face at the mental health level, if those are not addressed, that is actually going to impact for a lifetime that child's mental health….’’  What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.  
41:00 13/09/2023
The Critical Role of Clinical Research in Patient Care | E. 84
Clinical research has been around for over 300 years. Todd Nicklas explains why it still isn’t perfect but still offers benefits for patients and healthcare providers to Jim Cagliostro.    Episode Introduction  Todd explains the history of clinical research through Paul Offit’s You Bet Your Life, asks the big question of ‘’replacement or supplement’’, and explains why patients are always their own biggest advocates. He also explains the need for monitoring the ‘’gray line’’, and why the key focus in all clinical trials is failing early.   Show Topics   Clinical research isn’t always the answer for patients  Supplement or replace? The big question for balance Handling complexities in replacing medication  The high cost of getting drugs to market  Focus on failing early  Patient benefits: a case study with Camzyos Teamwork helps the growth process   03:35 Clinical research isn’t always the answer for patients  Todd highlighted the importance of a balanced view in clinical research, highlighting ‘’You Bet Your Life’’ by Paul Offit.  ‘’So I kind of wanted to start out with that sometimes it is the answer, clinical research for a patient, or sometimes it's not the answer.. I appreciate reading a book by Paul Offit called You Bet Your Life. And ..he went through the past few hundred years in some of the early medical interventions in development and when they were very early starting off, the first blood transfusions that were tried or first types of anesthesia. And when he would dive into those stories, I mean, Jim, there were dangerous approaches. We look back today, really wild, crazy ideas or people died or people had maimed arms and legs from radiology exposure and such, but it leads us to where we are today with radiology procedures and blood donation and transfusions and anesthesia. Just a few examples. He did a few others…So his approach was, there's a point, and maybe we'll get to this later, where you can kind of know where the risks are worked out, but you can't just write it off and throw the baby out with the bath water. There might be something still good here that we need to learn. And so sometimes it could be the answer like, look where anesthesia and blood donation is today. But sometimes it's not the answer. You can look back for the past few hundred years and health authority figures or people at various companies thought that lobotomies were a good idea or sterilizing the mentally ill or bloodletting. You can look at some of these things that today we'd say, yeah, they were dangerous or inappropriate or not what they were intending to. So people can be wrong and people can be right. And so you have to understand that balance first and foremost. I kind of wanted to stress that upfront.’’   06:01 Supplement or replace? The big question for balance Todd explained why this question is essential to balance in patient trials.  ‘’But I think the two questions you have to ask when you're trying to balance it is first, does the present, shall I say medication or intervention, does it supplement what is presently trying to treat or help my disease or does it replace the present? And the reason I wanted to lead with that or categorize that is because when I was a research nurse for many years in the hospital, you're working with sometimes doctors that really love the research that you're doing and are an investigator with that research. Some doctors could care less and tell you to go away and say, "Don't bother me. Really, you're going to bother me with this research?" Some doctors might have no clue because they're not even connected with your hospital system. And so how do you interact with doctors A, B, and C that I just gave as examples because you're going to have to approach them differently? I think that's probably self-evident. So you have to say, "Well, listen, it's meant to supplement and here's how it could work already with the present medical regimen that these patients are getting or it's meant to replace the treatment and this is why and this is how you should manage them." So I guess first, does it supplement the present treatment? This is I guess a question that research has to answer: how does the present treatment alone that they're already on affect a certain lab level or a MRI scan or a vital sign that might be concerned about your blood pressure or what have you, versus how much does it affect that measurable point with the two together or the research medication or intervention? We get a lot of time to dive into that, but I just want to leave that hanging out there to think about that.’’   10:08 Handling complexities in replacing medication  Todd emphasized the need for clarity with patients, hospitals and in documentation in ‘’replacement’’ trials.  ‘’When you're intending to replace the present treatment, well, then the doctors will say, "Well, wait a minute. When does that happen? Is there a washout period? What's the half-life of the drug that they're presently taking and the one that you want them to take in the research study? How quickly can it come on board and give a therapeutic benefit?" These questions, like I said before with the previous point, you need to be very careful in how you convey that to the patient, to the doctors, to the nurse practitioners, how it's in the documentation. Things can get forgotten, as you know. So it has to be clear in the documentation as well. You and I worked with LVADs, which are the heart pump devices. Could it replace their heart failure meds across the board? Maybe. If they have a really great response, maybe you can get rid of a good bit of them. And then the doctor would say, "Well, when would that occur? And how do we do that in the hospital?" So there are tough questions to ask and you might say... Oh, sorry, I forgot to mention this to you with the supplement. These studies are often with supplements, placebo controlled. Well, how do I handle... If I'm not supposed to know if they're on placebo or not, but it could supplement and have some impact, what do I watch for? What blood levels do I keep an eye on? But with replacement, that doesn't typically happen because they need a therapy, they need to be treated for something. So you have to either be getting the old medication or the research medication. It's not as much. So I wanted to mention that real briefly too, but that is another point I wanted to get across.’’   15:10 The high cost of getting drugs to market  ‘’Jim, let's say you have a compound, an asset, a drug for your company, and it looks like it could affect a therapeutic area or a disease process that could pull in two million in sales and another avenue that might pull in two billion in sales. Some people might be more led to the two billion regardless of everything else. So I respect that. However, you have to keep in mind, so I've acknowledged that there is some negative approaches to things that are not good and can be shady, but at the same time, research, if you're not in the space, it takes so much money to get a drug approved in the United States with the FDA because the FDA is very careful with understanding all the components that need to be in place and the data that needs to be understood to say this medication should be on the market….. the typical cost to develop a drug is $2 billion on average. And the average time it takes from saying, "Here's our asset in preclinical," which is kind of working with animals and such, to the time it gets approved is about 13 and a half or 14 years.’’   19:34 Focus on failing early Todd said that failing early would save costs further down the line.  ‘’Because the big focus today, and I think I might've mentioned the last podcast, is to fail early. So what a lot of companies like to do is to do a lot of high throughput, testing thousands of different compounds and various disease processes and targets in the body to understand where they might fail down the road, and there's amazing technology to figure that out, so they can hopefully pick the right one to go down that rabbit hole, shall we say, and hopefully get an approval because we know-it's such a big investment. And, oh, I didn't say this, but I think a compound, once it first gets found to get FDA approved through all the phase ones, twos and threes, it's like 5% or 10%, something really low. Even if things sound really appealing, the amount of drugs that actually get approved after all these things, we talked $2 billion, 13 and a half years, is still pretty small. Because the FDA is trying to be careful, they want to make sure something's safe and effective, that's the big thing. And it is great that we have both of those things that are important. You don't want something that's just one of those things, I mean safe but not effective, or effective but not safe. I mean both of those don't sound appealing to the modern consumer.’’   31:35 Patient benefits: a case study with Camzyos Todd provided an example of how individuals can benefit from research.  ‘’This is probably six, seven years ago now. I did a study with what's now Camzyos, or mavacamten, a BMS drug, and it helps patients that have hypertrophic cardiomyopathy, apologies if I used this last time, but I don't think I did, where it is an overdevelopment of the muscles of the heart to the point that it's typically pushing into the left ventricular outflow tract, which is the exiting tunnel, shall we say, out to the aorta, which goes to the rest of your body and provides blood to the rest of your body. So the muscle as it pushes into that area, it makes the opening smaller and smaller so less blood can go out to the rest of your body to provide blood to your tissues and organs. And at the point that we were doing the study, the only fixes or treatment were either surgery to cut down that muscle or beta blockers and things to reduce the blood pressure that maybe reduces pressure in that area, but those are difficult to really target long-term or even midterm. It does affect the small muscle fibers and you actually see a reduction in that muscle area. So the reason I say this is because I had a patient that did this and it was a very involved, I think it was early Phase 1b or 2a, pretty early on study where he had to come in weekly for 12 weeks and do echoes and MRIs and a lot of blood work. And some of the visits I remember with him, he was in his 20s, were maybe three, four or five hours long, very busy visits for sure. So the question is, I mean, he's a young kid, does he want to have this burden on his life to do all this? He had a good relationship with the physicians there that saw him, and I think that he really thought this could help him prevent downstream problems or give him a few years before that muscle was impacting enough that he might need surgery or what have you. So it was certainly his decision and it was inconvenient, like I said, those visits and such. But he had good results and I was able to, I believe it was actually open label, so I kind of got to see how things were going from his echoes and data and such. But even within the first week or two, we saw really impressive results from him.’’   36:41 Teamwork helps the growth process Todd said delegation prevents people from working in silos.  ‘’And I think that what I'm getting at is good delegation is not a negative thing and it doesn't reflect like you don't know what you're doing. I think we as human beings feel like, "Oh, I'm delegating so I clearly don't want to learn that, or I'm not good enough versus someone else." But no, what I found is, and especially now in larger pharmaceutical companies where there's a lot of team members, it's really beneficial to say, "Hey, you're really good at X, you're really good at Y. I should know them a little bit, and I do, and I oversee that, whatever, but I'm not going to jump in. I'm going to let you do it. Can you get back to me in a certain timeframe? Can you help me with this? Can you help me with that?"’ It's very beneficial because not only do you kind of know the lines in the sand where people are working and not working, you're respecting your skillset and theirs, and you're working together as a team rather than like, I'm in my own silo. I'm not going to look both ways. I am my own person. I found that to be really, really helpful, and you can learn a lot at the same time. It really helps you learn a lot more than just saying, "I'll do my own thing." I mean, yeah, you might be baptized by fire and learn it kind of, but you might learn it a wrong way, actually. So I think that's probably what I would say and what I've really appreciated in my growth process.’’   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Todd Nicklas on LinkedIn Check out VIE Healthcare and SpendMend    You’ll also hear:    The longevity of clinical research, starting with James Lind in 1747. ‘’We can't avoid research. We've been using the clinical research approach for the past 300 or so years….and then there were some studies that you can go back to even in the 1500s, that people would try various things to see what worked better than others.’’   Patients don’t live in a health vacuum: ‘’…..every patient you have is not going to be in a vacuum and have one disease and have nothing else. They're going to be 80 years old, they're going to have 10 other medications they're taking or four other disease processes that are going on. You need to know what's on board, what's working, what's not working.’’   Why the patient is the biggest advocate: ‘’..the thing I really appreciated most was telling the patients the nitty-gritty and really driving home the educational points because then they are there with doctors B and C that might not know or want to be involved in the study and they can say, "Wait, wait, hold up. Don't do this. Or maybe talk to Todd first because this might affect that."    Monitoring the ‘’gray line’’ in patient trials: ‘’Because some cancer patients do very early phase one and twos because they have to because of the development process or because of their cancer diagnosis or what have you, you might have to do early on. But are we past that line? Are we not? And what might that line look like? And that's why consent forms nowadays are extremely long because patients have to read all the safety data.’’   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.  
39:02 07/09/2023
Operational Efficiencies in Healthcare | E. 83
Around 100,000 nurses left the profession during Covid-19. Ryan Lee, CEO and co-founder of HireMe Healthcare, explains his passion for exploring and resolving giant problems at a deeper level, with Jim Cagliostro.   Episode Introduction    Ryan explains how appropriate staffing can transform patient outcomes, how nursing shortages haven’t changed much since 2001, and highlights the power of technology to humanize the hiring process. He also shares the #1 operational inefficiency, explains why there’s more to the talent shortage than burnout, and highlights the health system building meditation pods to promote staff well-being.   Show Topics   Trying to do more with less and less Three critical issues affecting patient care The talent shortage is about more than burnout The high cost of travel nurses Technology humanizes the hiring process High staff turnover makes nurse training difficult Two key strategies to transform operational efficiencies     10:41 Trying to do more with less and less  Ryan said Covid highlighted the extent of operational inefficiencies in healthcare.  ‘’(Studies) …found that the increase in responsibilities, the increase in travel nursing and the decrease in resources, greatly exacerbated the mental health strain on nurses. And this is obviously a tangent into how it's become a bit more uniquely of an American problem... We feel it a little more here than in others, but they also found that to be more common for hospital nurses, which checks out. But one of the best ways I've heard it said was speaking with a nurse manager from a major healthcare facility just the other day. It's about trying to do more and more with less and less.  Yeah. And I was actually just speaking with a neurocritical care doc this morning and knowing I was coming on here, I said, "What would you say is the number one operational inefficiency in a healthcare system?" And she said, "There's too much administrative red tape put in place by too many people that don't have bedside experience." And that's not to say you don't need people with different backgrounds, it's critical to have that. But it was interesting to hear, and those are her words, not mine. But it's interesting to hear that take and these operational inefficiencies, and I am definitely way more qualified to speak to this in a nursing staffing context. So it just comes down to how much turnover there is. ‘’   14:53 Three critical issues affecting patient care Ryan explained the impact of inefficiencies and said appropriate staffing could improve these areas.  ‘’There's patient satisfaction for one, which with the rise of value-based care is an increasingly important metric, but the other two are patient outcomes and efficiency measures. And having safe staffing, which is also called appropriate staffing or evidence-based staffing has been shown to improve all of these components. So for patient outcomes, I mean you have anything from the frequency of cardiac arrests, a lot of it just has to do with what happens when patients are in the care of understaffed units. So an increase in cardiac arrest with subpar staffing, an increase in HAIs (hospital acquired infections), which can amount to tens of billions of dollars nationwide every year. That's a really expensive one. More instances of respiratory failure, failure to rescue becomes more common. And overall it increases inpatient mortality rates, which is the very goal of a hospital to avoid. And on the efficiency side, it impacts readmission rates, the length of stay, the turnover time in an operating room, the average time in the emergency department. And coming back full circle, it impacts the staff retention, which it's this vicious cycle that self perpetuates where nurses are understaffed, working in an understaffed unit impacts mental health and wellbeing, which leads to burnout, which leads to more turnover, which leads to more understaffed units. And then it's just this cycle, it's really terrifying to look at because of what kind of an impact ... ‘’   17:32 The talent shortage is about more than burnout  Ryan said issues causing the staffing shortage haven’t changed much since 2001.  ‘’…..there is truly a talent shortage. That's a real thing. It's not just this burnout phase, this increase after COVID, nurses fed up with the status quo and everyone leaving in droves. We lost 100,000 plus nurses last year. It's not just that. There is an actual talent shortage here, and that comes from several things. There's a pipeline issue, for instance, education is a huge ... There's a shortage in faculty talent to train our nurses. There's way more qualified applicants for nursing schools than there are available seats in nursing schools. That's part of the recent ... A hundred million that the Biden administration just pledged to attack the nursing staffing crisis is addressing the education pipeline. So it'll be really interesting to see how that plays out. …..But there is a talent shortage and there's reasons. If you go back, I'll look to this survey done by an organization, a think tank called Health Workforce Solutions. This was in 2001 where they talk about the reasons for the American nursing shortage. And it comes down to an aging population, still more true today than it was back then. They were talking about Gen X being the primary generation in the nursing workforce, which now we're looking at Millennials, an aging nursing workforce, still the same. The average age of nurses is over 50, nationwide. They had to do a lot with the work environment. They said fewer resources and more demand. This was in 2001. None of this is new. … Everyone in a healthcare environment needs more money… There's so many different demands on finance, and often the nurses struggle to enact changes.’’    23:44 The high cost of travel nurses  Ryan explained how the pandemic changed the culture of travel nursing  ‘’… the real basis for travel nursing was living in various places, having an adventurous life, getting a chance to fill in where needs were at a temporary high in certain areas, be it flu season, whether you're doing it to go fill in for a flu season in St. Louis or whether you just want to live in Denver, Colorado for three months. That was the basis of travel nursing up until the pandemic really. And that's when labor costs just skyrocketed for that. And it became almost imperative for the nursing side. You're looking at people making two, three times as much as you and the hospital's paying eight times that at some points. I mean, the average cost for an hour of agency labor got up to 275 an hour during the pandemic, which is utterly insane. That would be amazing money for a nurse if the nurse saw even close to half of that. But the average pay for travel nurses was still around $125 an hour versus the usual $50 an hour. I mean, so you're looking at being able to afford two and a half FTEs for the same price as a travel nurse, but why would you go take an FTE position when you can make almost three times what you're making? So it made sense for nurses to take on these roles. I knew a lot of nurses who were living in Charlotte and working in Winston-Salem, and they were technically a travel nurse, but not like when you were a travel nurse, Jim, where you moved to California to do your job. They were just driving from Charlotte to Winston two hours every day, and that made them a travel nurse and eligible for that kind of pay. So that's the system we made. And obviously, I mean, our health system nationally spent $24 billion in one year just on travel labor, which sounds absurd, but when you do the math, 275 an hour spent times our workforce that shifted into travel and the hours demanded of a short-staffed healthcare system. It was quite amazing to say the very least there.’’   28:34 Technology humanizes the hiring process Ryan explained how HireMe Healthcare technology makes the application process easier.  ‘’From the hiring side, it makes it more efficient, it simplifies it, and this may sound strange given that it's technology based, but it humanizes the process. And that's what HireMe Healthcare sets out to do is to humanize the process.. So let's go from the nurse perspective first. So you are applying for a job, but you're applying for multiple because you want to find that right fit. So you're going to fill out a new application, your resume exists, but it has no point because you have to fill out applications for hospital systems through their system and through their portal individually each time, typing the same information over. …technology can play a role by offering a one-stop shop personal profile. … it's a great way to have all the necessary boxes that need to be checked for a specific job can be in one place, and then you get to take the quick step forward towards the human side of the process. Is this nurse a good fit? And HireMe Healthcare uses matching technology to pair nurses based on individualized nurses, individualized job descriptions, looking to find the person behind the resume, and the person, the people, the team behind the job description. It's not just quantitative….. I mean by having our one-stop shop personal profile, and then each customized job description, it allows hiring managers to have these candidates ranked for them just based on the check boxes and the components. And then adding in qualitative components to find out what kind of a fit someone's going to be on a particular unit.’’   34:46 High staff turnover makes nurse training difficult Ryan said when nurses ‘’flip’’ every 30 to 90 days, effective training isn’t possible.  ‘’… Right now, it's hard to really focus on training your staff when they're turning over as quickly as they are. A lot of first year nursing students or first year grads entering the nursing workforce, they turned over some 36% I believe it was last year, and they're losing a third of grads that need the most training of all right off the bat, and that means they're going to bounce to another job. … if you're flipping to a new hospital every 30 to 90 days, like travel nurses or disgruntled first years that have a, this isn't what I expected. They're not around long enough to endure the proper training that they need. And also training comes into requiring resources, and those resources like the resources for hiring and everything else are becoming more scant, the time spent. We talked about, oncology is actually a great example of this. It's a hyper-specific practice that has a bunch of, just as they describe it, little things that make it very unique that only are necessary for oncology nursing, but they don't have the wherewithal to hire someone full-time, someone who's trying to transition into oncology. They don't have the resources to hire someone and just employ them full-time for the training necessary to become masterful in such a critical practice that has so many nuances. This is true across the board that not having enough resources to train your nurses leads to subpar training. And a lot of that training focuses, as I said, on protocols and those protocols can be unique.’’   40:02: Two key strategies to transform operational efficiencies  Ryan said embracing technology and taking action on mental health can make a difference.  ‘’… a couple of things we've seen have been very effective, authorizing critical staffing pay has worked. Nurses getting paid for what they're actually up against. There's building in-house nursing staffing pools, float pools have been very effective within to really have labor that understands your protocols on hand. That's been very effective. Nurses like getting paid more, but when you really talk about what's the real trigger here, it's not "If I got paid more, I would be happy in this job." The most effective measures hands down are those that address the mental health and wellbeing of nurses. And I also see a lot of efficacy coming from those that are embracing technology. … And I would say the two biggest things hospitals can do are treat their nurses well, and I mean actually taking action towards mental health. Novant Health is building meditation pods, for example. I thought that was something really cool.‘’     Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Ryan Lee on LinkedIn Check out VIE Healthcare and SpendMend    You’ll also hear:    From law school to HireMe Healthcare via Uganda, a passion for human rights, and a pandemic; Ryan’s varied career journey.  The current vacancy rate in nursing is causing problems in achieving nurse to patient ratio. ‘’… right now it's at 16% a little over, which is a lot of gaps to be filled. That's a lot of nursing positions that are needed.’’ The impact of Covid-19 on nursing turnover. ‘’At the height of the pandemic, turnover got up to almost 30%. It was a little over 28. And so that's almost a third of the entire national workforce just turning over. And that doesn't include the specialties that had significantly more.’’ How using an old address on a resume can filter applicants out, rather than in.  The impact of asking for nurses for voluntary overtime. ‘’According to the NSI retention report, 99% of hospitals are doing this, and it's not very effective as you can imagine, especially if we look at the impact on nurse wellbeing and nurse mental health.’’ Leadership lessons: The far-reaching impact of burnout versus the need for self-care, compassion, and gratitude. ‘’The best thing you can do for other people is take care of yourself.’’    What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.
47:57 30/08/2023
How Tech Transforms Echo & Medical Devices | E. 82
Cardiovascular disease is the leading cause of death in the US. Clifford Thornton explores the impact of technology on medical devices, cardiography and treatment, with Jim Cagliostro.   Episode Introduction  Clifford explains the two types of echocardiograms, the benefits of 3D versus 2D echoes, and why it takes $72 million and a decade to launch new medical devices in the US. He also highlights how spending on cardiovascular care has risen to $600 bn a year and offers a Top Gun analogy to emphasize why healthcare leaders must carry out competitive and environmental scans.    Show Topics   Two different types of echocardiogram  Advances in technology have transformed echocardiography 3D echo versus 2D echo A $72 million barrier to new technology  Choosing the right medical device for your patients Staying ahead in your market (learning from Xerox)      05:50 Two different types of echocardiogram (echo) Clifford said there are two main types of echo, surface and invasive.  ‘’So to really answer your question, echo is basically an ultrasound or sonogram of the heart, which is why we also refer to it as a cardiac sonogram. So those who perform this test are called an echocardiographer technician or a cardiac sonographer. There is a movement to change it to an echo specialist. Some people are not so thrilled with the technician annotation. I don't have a problem with it, but there's some discussion around that just for everyone's awareness. Of course. So echoes, they can be broken down into two main types and they basically use a different type of probe. One is on the surface and one is invasive. I say invasive, but through the esophagus. I guess it is invasive. The more common and more easily performed surface echo, or you can call it a vanilla echo, is the transthoracic echocardiogram, which we also call a TTE as an acronym….So that's the one type and the other, and this is a little more complex, this requires a healthcare team, a clinical team. So it requires the performing cardiologist, whereas the surface echo and echo tech can do it alone, just the tech and the patient.‘’   10:34 Advances in technology have transformed echocardiography Clifford said both patients and healthcare employees benefit from the impact of technology.  ‘’Look where we've gone from our Texas instrument scientific calculators to smart watches. And I remember always running with the Sony Walkman, the Sony cassette Walkman and the Discman, and now we have iPods. So echo is no different. It's amazing, right? To answer that, echocardiography and its related technology because as we know, it relies a great deal on technology. So meaning the design and engineering of the cardiovascular ultrasound systems, it has actually evolved immensely since the beginning, and that was about 40 years ago. You see as techs, we joke around about those early machines that were beef, like little tanks to push around. And just like other techs, they've gotten more and more compact and lighter. And that of course makes techs’ lives much easier and more ergonomically friendly. I'm sure you know from a nurse's standpoint, how important that is. Actually, the number one occupational injury for nurses is moving patients in the country, ergonomics. So we as techs love these new machines, me included. So for example, one thing I love about what's called the Philips iE33 system, it's one of their more modern systems is that the monitor actually pivots for angles in different directions to so many physicians. It's really neat. So since I'm actually an oddball, lefty scanner, most echo scanners are righty, for me that's super helpful. Most ready techs, they're facing away from the patient, but the positive for lefties is I'm facing the patient. They can actually look at the screen. So this type of flexibility with the machines, it's a godsend, especially for bedside echoes where we go and do the echo in the unit.’’   13:17 3D echo versus 2D echo Clifford said 3D echoes give a more real perspective of the heart, enhancing interventional procedures and patient care. ‘’Really though, the most meaningful advance for echo, what really has changed, it has been the growing availability use of 3D echo versus the standard 2D. So there's been a growing availability of 3D echo over the last decade or so. And today I would say there's about 75% of availability of 3D echo….about 35% of all US labs probably use it routinely. So you can see it's become pretty standard. The clinical benefit, it may not be readily apparent sometimes, but I thought it was pretty neat. I definitely found it to be a more real perspective of the heart. But there really is a benefit to the 3D TEE, and it actually plays a pivotal role in the growing prevalence of interventional procedures. Especially things like transcatheter valve replacement. Some other important advantages of the 3D echo include it eliminates geometric assumptions, quantifying complex geometric shape volumes, the ability to view structures from any perspective, and also assessing a lesion in what we call simultaneous multiplane. So with 2D echo, as tech cardiologists, we have to kind of imagine things, but the 3D gives it more of this real visualization.’’   17:17 A $72 million barrier to new technology   Clifford said it takes a decade and $72 million to launch a new medical device in the US.  ‘’On average, it costs about $72 million to start a new medical device in the United States. You need a good amount of money. It's a dynamic, but very challenging intersect between the medical science and business. But I would say the main challenge with all this is it takes around a decade, and I know you're very familiar with this, it takes around a decade or more to develop and refine and test these medications and new medical devices. What could happen in the span, the market evolves and you see new entrants, the economy changes. So this timing aspect, Jim, it's really difficult, extremely difficult. Also, unfortunately, we've seen a lot of biotech, venture capital firms actually exit the United States or pull back significantly. I think the risk is scaring a lot of people. Very risky. For those launching something in this space, some advice. I would say, you really want to make sure it is quite novel and really have a compelling case and the proof of concept, that's your bread and butter. That's a critical early milestone.’’   20:39 Choosing the right medical device for your patients  Clifford explained the key elements hospital leaders should consider in choosing the right medical device.  ‘’Yeah. That's another very important question. It's become difficult to sort through it. You're right there. So my underlying philosophy that I learned from experience and also by studying a lot of successful leaders is that you want to always aim for high quality and strong results. Okay? You want to have your binoculars pointed in the right direction and everything should fall behind that. With that being said, I think the key for hospital leaders is, one, they want to look at how the technology, how it fits into their existing suite of services and how it aligns and how it can bolster their existing services. Two, they must consider if they have the infrastructure, the staff and the resources to support a certain program, say like what we talked about, their percutaneous valve replacement. If they don't have the tools, it doesn't mean never, it means now they need to start building and selling a business plan to amass that capability on all levels, which means the tech, the staff, and related expertise and the infrastructure. Build a business case for that. There are then... Of course, we talked about before with the medical device tiers, the regulations. You got to take that into account.’’   28:59 Staying ahead in your market (learning from Xerox)   Clifford said competitive and environmental ‘’scans’’ are vital with rapid advances in technology.  ‘’And finally, I think this is really key. We talked about this, the piece of change. We talked about the windows of opportunity and so forth, and what we need to do or leaders need to do, and I mean they need to do this constantly and also rigorously, is to do what we call from marketing people, we talk environmental or competitive scans. And the reason for this is you never know what technology or competitor can come out of a field or to identify new opportunities. A lot of people know Xerox was invented some of the early internet technologies, but they just didn't capitalize on it. They maybe didn't look at the competition out there. And now we have Google and there was Netscape and then Google, and the leaders out there. Now Google almost dominates online advertising. So you want to be aware of what's out there…. on average today, companies have only about a three-year window to make a profit on a given product or service.’’   Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Clifford Thornton on LinkedIn Check out VIE Healthcare and SpendMend    You’ll also hear:    Inspiration from his uncle, and a passion for fitness; Clifford’s journey into cardiology.  Putting the power of a human heart into context: ‘’They say in a lifetime an average heart pumps enough volume of blood to fill more than three super tankers. So just to give you a picture that equates to around 1 million barrels of blood.’’ Why a good pair of shoes is critical working in cardiac care: ‘’….for one of my first or early echo jobs in Naples, Florida, the job description listed the ability to walk, I kid you not. seven miles per day as a requirement for the job.’’   Keeping the focus on people: ‘Just an example, in New York state, they just made a certain nurse to patient ratios mandatory, meaning it's a state law in their intensive care unit. So they have to adhere to these nurse to patient ratios in all New York ICUs now. So managers, they need to work around all these kinds of things and take it into account.’’   The cost of treating cardiovascular disease: ‘’…shortly after Medicare was instituted, cardiovascular spending in the United States jumped to around 100 billion a year within 10 years. Today that figure how much we spend on cardiovascular to treat cardiovascular disease in the US is 600 billion a year. And globally, I would say it's around 1 trillion.’’   What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at or directly at 732-319-5700.
33:23 23/08/2023

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