Ron Williams, Chairman & CEO of RW2 Enterprises and former Chairman & CEO of Aetna
If one attempts to look at health care through the many lenses it can be viewed through, what does one ultimately see for the future? Ron Williams has a long and distinguished career in health care and has seen the system from many different viewpoints–as CEO of one of the largest health plans, board director to pharmaceutical medical device and consumer health care companies, and private equity advisor. His view of the future centers around the personalization and globalization of health, by way of accelerated adoption of sensor technology, artificial intelligence, advanced payment models, and robust debate facilitated by government around the future of health and care.
Ronald A. Williams is Chairman and CEO of RW2 Enterprises and the former Chairman and CEO of health insurance giant Aetna Inc. He’s the bestselling author of “Learning to Lead: The Journey to Leading Yourself, Leading Others, and Leading an Organization.”
Mr. Williams counsels C-Suite corporate executives on strategy and transformational leadership. As Operating Advisor to private equity firm Clayton Dubilier & Rice, he oversees portfolio companies including serving as Founding Chairman of agilon health and Chairman of Vera Whole Health. He previously served as Chairman of naviHealth and PharMedium. He is a Director of American Express, Boeing, Johnson & Johnson and Warby Parker.
Mr. Williams is Chairman of The Conference Board and member of President’s Circle of the National Academies, American Academy of Arts and Sciences and trustee of CED.
He’s a graduate of Roosevelt University and holds an M.S. in Management from MIT Sloan School of Management.
Show Notes
Ron Williams varied background includes health insurance, pharmaceutical medical devices and consumer health care, and emerging health care innovations. [03:06]
A future vision of health care that offers accessible high quality care, prevention and a holistic system focused on wellness. [04:11]
How can we create this future? [05:27]
What’s the benefit of personalized data and will it be secure? [06:51]
What does a global health care system look like? [08:34]
Can team-based care solve the health care workforce shortage? [09:32]
How can technology be used to assist a patient? [12:26]
The role of government in global health care. [13:44]
How can we ensure equitable access to health care? [15:50]
Who will fund the innovation in health care? [17:49]
How can we make expensive innovations, like cell and gene therapy, accessible to all? [19:51]
What are the broader implications of extension of life using gene editing? [22:42]
A health care vision that unleashes a level of creativity, engagement, productivity and personal fulfillment. [24:40]
Transcript
Jason Helgerson 0:04
I'm Jason Helgerson, and you're listening to Health2049.
Ron Williams 0:08
I believe that it will be a human led interaction and yes, there will be a place for technology. That technology might be sensors, that technology might be artificial intelligence that's used for prompts, aids, and coaching to help the patient. But it all has to be under the guidance of your physician. I don't see machines replacing the judgment of physicians who really need to lead that care team, both from a physical medicine, but then also the appropriate mental health and wellness specialties.
Jason Helgerson 1:57
Today's guest is both a visionary and a successful executive. He's been on the leading edge of American health care for nearly 30 years, including many years at the head of one of the nation's largest health insurers Aetna, where he served as chairman and CEO. Ron Williams is also a highly sought after board member and corporate advisor, and currently serves on the boards of American Express, Boeing and the world's largest health care company, Johnson & Johnson. In addition to his work leading large organizations, Ron is committed to supporting startups and nonprofit organizations that share his commitment to making health care better for all. Ron is also one of the few black male executives in an industry that is still woefully undiversified, where women and minorities in positions of power are sadly still the exception. I'm Jason Helgerson, and you're listening to Health2049. And it's my pleasure to welcome Ron Williams to the program. Ron, welcome.
Ron Williams 2:57
Well, thank you. It's a pleasure to be here.
Jason Helgerson 3:00
Well, great, Ron, maybe you could tell our audience a little bit more about your interesting background?
Ron Williams 3:06
Well, I would say that I am extremely fortunate, I have seen the world from the vantage point of one of the largest health plans in the country. I also have seen the world from the vantage point of one of the largest pharmaceutical medical devices and consumer healthcare companies. And then in my private equity work, I have seen healthcare from the vantage point of innovative, emerging companies that have found very important problems and unmet needs in the healthcare system, and have developed innovative solutions. So I joke that sometimes I have very vigorous conversations with myself, based on the different perspectives I've seen in the healthcare system.
Jason Helgerson 3:50
Well, fantastic. A key reason why you're such a great guest for our show is all the different perspectives that you've had throughout your illustrious career. And, and so I'm very excited to be able to ask this next question, which is the question we ask all our guests, which is, so what does health and healthcare look like in the year 2049?
Ron Williams 4:11
Well, I wish I had a clear roadmap, and I don't but what I have are aspirations that reflect what I hope the world is like then. I would start with the fact that everyone has access to high quality care that helps them live a full and fulfilling life. And that care is preventive in its nature. It's holistic in the sense that it deals not just with the physical health, but it deals with their mental health and well-being and that the system itself is organized around wellness, and that it is a global system that doesn't just provide that level of care to people who are privileged and who live in the right zip codes, but people who, wherever they live, have access to that.
Jason Helgerson 5:03
Great. So that paints a very clear sort of broad picture. But maybe we could drill down or tap into a couple of aspects of what that system is going to look like maybe from a patient's perspective. How will the patient experience, or maybe even instead of use the word patient use person or family's experience, how will they experience the system? What will it be like? And how will it differ from what is experienced today?
Ron Williams 5:27
I would start with the fact that today, families seek medical care when they have a symptom or a problem. And I think in the future, we will have a level of data, digitization and sensors that will monitor the state of health that individuals have, it would be highly private to the individual and the family. And I think there's a huge opportunity for the digitization, the personalization of health care to engage with each person in a way that that person is able to really understand what they need to do in order to maintain optimum health and well-being.
Jason Helgerson 6:13
So in a sense, you're talking about basically almost 24/7, 365 day monitoring in interaction, in interface between the system and the individual or the family unit. A lot of people are excited about the role that technology can play, but all that data being collected, talked about it being private, being protected. Do you have any fear that this data could in essence, be used in sort of nefarious ways? Or that people may rebel against the idea of being monitored as aggressively as maybe what you described?
Ron Williams 6:51
Well, I would say there are always concerns and fears. If we look at the amount of financial data and financial information that's readily available, and is it misused? Yes, there are instances where it is. But by and large, society is better off. I think it's important that it'd be voluntary. If people don't want to do it, they don't have to, but there's a cost of their well-being and health that they would bear. And if they so choose that, that would be an option open to them. I think like most things that are new and innovative, it takes time for people to become aware of it and get comfortable with it. But if we think about the devices we have today, where you can have a device that tells you, did you take enough steps today? Did you get enough exercise? Did you have a trip and fall and should someone be called to assist you? We're seeing the beginning emergence of this kind of technology. So it's not an electric switch that we'll throw all at once. And we will go through an acclamation period. I think concern is healthy. And I think people should think meaningfully about how this data would be used. But I think it's important that we not slow down the progress, because it will radically transform the health of individuals.
Jason Helgerson 8:10
Interesting. So one of the aspects of your global worldview, your vision for the future that I found interesting, that sort of differs from a lot of the guests we've had on the show, is you see it as a global system. Can you maybe get a little bit more into that because to a great extent, the water's edge and healthcare is the national border. Tell us a little bit more about what a global health system looks like.
Ron Williams 8:34
One of the things I've learned is that the healthcare system in every country unfolds in a cultural context, that country's history, and that country's cultural preferences. So I don't think we can have a one size fits all. The UK will be very different than France, which will be different than the US that will be different than Brazil. The one thing that's common is that germs travel at the speed of a flight. And so there has to be a system that takes care of everyone.
Jason Helgerson 9:07
So let's talk a little bit about the providers in the system in 2049. And a lot of concern around burnout and individuals just feeling overwhelmed by the task of being a healthcare provider in this environment. Do you see the experience of a provider being fundamentally different, their role changing, and if so changing for the better?
Ron Williams 9:32
Well, I think we owe the whole clinical community an enormous thank you for the work that they've done during this COVID crisis. And I think they've been underappreciated, I think when we think about the future, what we have to recognize is right now we have a fundamental shortage, particularly in the primary care area, and that we're going to have to think about, how do we shift care from individual physicians to a team that is under the guidance and supervision of that physician, and that we create new roles and make maximum use of the nutritionists, the physical therapy, the physician's assistant, the nurse practitioner, and that we help the physician shift from a fee-for-service system where it is transaction-based, they get paid to see a person at a moment in time, if they don't see them, there's no payment, and many of the services that they have to provide, there's no code for. What code do they submit to be reimbursed to put a person in an Uber or Lyft to bring them into the office to be seen to avoid a trip to the hospital? And so we need to go to a system where the physicians are paid an aggregate amount to look after a group of patients who have selected them as a primary care physician. Those physicians need to be supported through the digitization of health care by really combining the understanding of the disease mechanism, the best clinical practices, and the state of the patient's condition based on their lab results, based on their biometric data that they're willing to share voluntarily, based on the degree to which they have a health care condition that requires more intensive care. And so instead of being the sick care system, that the doctor sees you when you have a symptom or a condition, the doctor is proactively scanning that data and intervening to assist you to avoid that condition progressing to the maximum extent possible.
Jason Helgerson 11:50
Interesting. So what you just described, which is certainly music to my ears about the need to move away from fee-for-service reimbursement and the perverse incentives it creates, but that future state you're describing is still very much about human beings providing care to human beings. Do you see a real increasing role of of technology, computers, artificial intelligence, being more of the interface between the patient and the system? Or do you think that by the year 2049, it's still going to very much be a human to human type of interaction?
Ron Williams 12:26
I believe that it will be a human led interaction. And that, yes, there will be a place for technology, that technology might be sensors, that technology might be artificial intelligence that's used for prompts, aids, and coaching to help the patient. But it all has to be under the guidance of your physician. And that physician will have access to data, to information, to artificial intelligence that may very well prompt them that says Mrs. Jones' blood pressure seems to be outside of the acceptable range today. So the nurse practitioner, or the nurse assistant needs to reach out to Mrs. Jones, and determine Is there anything going on that requires an intervention. I don't see machines replacing the judgment of physicians who really need to lead that care team, both from a physical medicine, but then also the appropriate mental health and wellness specialties.
Jason Helgerson 13:31
Gotcha. So let's talk a little bit about the role of government in the future system that you see, what will be the role of government in the US but feel free to go beyond the US as well?
Ron Williams 13:44
Well, I think each country has to reach a decision, as I mentioned, based on its culture, its history and its citizens preferences, about what is the mechanism to fund the health care system in the country. And there are really tough decisions that governments will face. For example, as we make progression in things like genomics, the use of CRISPR technology, the use of the ability to eradicate disease through intervention, some of these procedures and technologies will be incredibly expensive. And the question will be, how does the government decide? And how does that society decide who gets what? And that is a place where I think the government can facilitate, can guide, and can help create mechanisms, because people worry a lot about rationing care, and all countries ration care. Some countries ration it through a system like in the UK, where there's a group that evaluates technology and figures out, is this something that is worth applying and to whom is it an investment that the country should make? If you're 95 years old, we're not going to give you a hip replacement. If you're 55, you'll get a hip replacement. In the US, we ration economically. If you live in the right zip code, you get 10 to 20 year extension on your life, if you live in the wrong zip code, your life is shortened by 10 to 20 years. And so I think the government has to sort through this in a way that is equitable to the citizens.
Jason Helgerson 15:26
Are you optimistic, let's take the United States, do you think that by the year 2049, that the government, at the at the national level, or maybe in certain states, at the state level, will be able to solve this conundrum, we'll be able to figure out how to ensure equitable access to health care, are you an optimist when it comes to that question?
Ron Williams 15:50
Well, the answer is I'm an optimist, I have to be based on what I've accomplished in my life, and what I've been fortunate enough to achieve. And I have watched the level of insurance coverage increase dramatically in the US, we're not where we need to be. But we have made very, very substantial progress. We have a ways to go and I do believe that by the 2049, we should be in a place where every person has health insurance, and every person has access to coverage. I think the debate will be what level of entitlement is as each person has. Does every person have coverage up to $5 million? Does every person have coverage that's unlimited? And you can imagine a world in which if we spent $5 million on every person preventively to keep them healthy and alive, we could do so. The question is, would we have the resources? If we did, hooray, we should do it. And if we don't, then there are tough decisions that society will have to decide.
Jason Helgerson 16:59
I hear you loud and clear on that. And I share your optimism that at least in my view, the arc of history is bending in the right direction in terms of the uninsured rate in the United States coming down and access increasing by 2049, roughly 30 years in the future. Let's move on to innovation in the sector and the role of companies like J&J or others, how do you think we're going to be funding innovation in health and health care in the year 2049, government, private sector, a lot really falls on the backs of of the United States at this point to fund it for the world. What are your thoughts on funding innovation in health and healthcare sector?
Ron Williams 17:45
By 2049 I think the system will continue in the direction that it is now which is public private partnerships. That certain core fundamental research is often funded by government and universities. And that research helps us understand the disease mechanism for a variety of conditions. Once that mechanism is understood, then the private sector goes to work trying to find the answer of how do you defeat that disease mechanism and address that unmet need for a cure or for mitigation of the situation. I can tell you that the private sector, pharmaceutical industries literally spend billions of dollars a year on therapies that are proven either not to work, or have side effects or indications that are unacceptable. And I believe that in the US, the FDA does a really excellent job to do its best to make certain that those treatments are safe and effective. And I think when we set the clock forward, the technology that is unfolding, particularly around gene therapy, will change the type of care. We had oral medication, we had injections, and we actually will end up at a place where more of the treatment may very well be at the cellular level in the context of genomics.
Jason Helgerson 19:17
Yes, so maybe we could dive a little bit more to cell and gene therapy in particular, tremendous optimism around the ability to cure diseases that had been seen as incurable, obviously new treatments, particularly in areas like cancer, a lot of rare diseases, but also concerns about the cost of those treatments. Do you think that they not only will cure disease, do you think that there will be things that nations and economies will be able to afford and at least certainly be able to afford for all of its people?
Ron Williams 19:51
Well, I think one of the things I've seen is that many therapies do start out expensive, but over time the cost of those therapies come down and become much more affordable. They're still not cheap, they're not inexpensive. And that's because of not only the work necessary, but the highly specialized testing, training and evaluation. I think that like most things, as we scale these treatments, we will come up with mechanisms to finance, the level of care that is warranted here. You think about insurance, insurance was based on the concept that an individual alone couldn't necessarily pay for the entire cost of a heart transplant. But if we pooled everyone together, and we set a premium for that, then we could have resources available for those unfortunate individuals who needed that procedure. And I think these high cost therapies will in fact, result in the development of new financing and funding mechanisms over time. The thing that is important that we not do, we should not stop the development of these solutions. Because it is expensive, they do start out costing a lot. But over time, as they are perfected, as they are scaled, and they figure out how to do it in a less expensive way. And there are competitors in the market with that therapy, the costs come down. So I think it is going to be an important issue that we will have to solve and I'm optimistic that we'll solve it.
Jason Helgerson 21:36
Great. So one more question I've got for you in this area, dying to hear your thoughts on this, one of the emerging treatments or ideas that's coming, is the idea of gene editing, and the idea that perhaps we'll be able to identify the genetic causes for various diseases and actually be able to edit genes to be able to prevent those chronic illnesses. And if we're able to do that systematically, we could extend human life well beyond what we see today. And sometimes people are predicting that by even maybe by the year 2049, that life expectancy for individuals in certain parts of the world could be as long as 125 years. And if we get to that point, one, do you think that's in fact possible, doable within the time horizon of 2049? And does that excite you? Or does it also maybe raise some concerns about broader implications of such an extension of life?
Ron Williams 22:42
Well, look, that's a huge question. And I think I would say that the answer quite honestly is we don't know. When the whole idea of mapping the human genome was first thought of, and when we first completed the mapping, there were great expectations about what that would mean for our ability to intervene. And it turned out that it was incredibly more complicated than anyone ever imagined, and the interaction between different elements of the genome were not well understood. I think that any attempt to intervene really does require very careful review and control. And I think the question is, are you intervening in the case of an individual? Or are you intervening in the whole genomic sequence that will occur going forward? And I think those are fundamentally different questions. I'm not an expert in it. But I think we do need the consultation of ethicists, of scientists, different religious communities, to really have vigorous debate about what is therapy, what is change? And how do we make those in a way that's responsible? I would say that if I could live to be 125, and be in reasonable health and be cognitively functioning, sure, I would certainly want to do it, and I think many people would. And the question is, how do we get from where we are to there? And on the way there, I would take 105 and consider that a big way.
Jason Helgerson 24:17
I'm with you, I'd be very, very happy to get to 105. So, the last question we always like to ask our guests is to take a step back and think of your vision for health and health care is in fact achieved by 2049, it's a very compelling and optimistic one that you shared with us today, how would that make society, the world a better place?
Ron Williams 24:40
Well, I think that it would make society and the world a place that would unleash a level of creativity, engagement, productivity and personal fulfillment. That is something that people have dreamed about and talked about. If you think about the average life expectancy 100 years ago, versus 100 years life expectancy today, if you think about the technology of 100 years ago and the technology of today, it would be magic, from the point of view of looking at things in 1921, or 22. And so I think if we set the clock forward another 50 years, and can accomplish the things that we're on the cusp of doing, I think we stand an opportunity to really make certain that there is true health care and a fundamental improvement in the health status of people all over the world. And those in zip codes in the US today who are not getting the level of health equity that they should be getting. And you can go down the list whether it's Africa, China, Latin America, there's an enormous amount of unmet medical need that desperately needs to be addressed.
Jason Helgerson 25:56
And that was Ron Williams vision for health in the year 2049. As always, thank you for listening to Health2049 If you enjoyed what you just heard, please subscribe to us on Apple Music and Spotify. And share this podcast with a friend. Thank you and see you next time.
