Health2049 Season Two Recap with Bruce Mau
Another amazing season packed with wisdom from a diverse group of healthcare thought leaders has wrapped. Podcast co-hosts Bisi Williams and Jason Helgerson, along with insight from moderator Bruce Mau, explore common themes, innovative therapies, cutting edge technology, personalized medicine and the role of politics and economics in health care. What inspired them? What’s on the horizon for Season Three? Listen in to discover health care challenges that are creating incredible opportunities and meet the inspiring guests who are at the forefront of change.
To learn more about our Health2049 podcast co-hosts, please visit our hosts page.
Show Notes
Moderator Bruce Mau points out highlights from Season 2 guests and looks for common threads. [2:06]
Co-host Jason Helgerson explores key themes that he saw throughout the season. [2:54]
Co-host Bisi Williams weighs in on her overall perspective of the past season. [4:33]
Is our healthcare future more or less optimistic? [5:45]
What can the insurance companies learn from the episodes? [8:24]
How has Medicare in the US influenced health care spending? [11:52]
Why are emergency medicine doctors so important in creating a value-based care system? [13:23]
How are hospitals being challenged to provide services differently? [16:10]
What are the key takeaways for the health care consumer? [20:24]
What perspectives and new big ideas should Season 3 focus on? [26:08]
Transcript
Bisi Williams 00:06
Welcome to Health2049. I'm one of your hosts, Bisi Williams. Today we're proud to present our Season 2 wrap up show. Over the course of the next 30 minutes, we'll look back and discuss the amazing insights provided by the 16 incredible individuals that we had the pleasure to interview this past season. Joining me today are my co-host, Jason Helgerson, and the one and only Bruce Mau, who will help moderate our discussion. Jason, what are you hoping to discuss today?
Jason Helgerson 01:40
I'm looking forward to not only a rewind, but also look ahead to Season Three. The response to the show has been amazing. And there are so many great minds we can tap to provide us with optimistic visions for the future. I also can't wait to hear what my friend the famous designer, author and big thinker extraordinaire Bruce Mau has to say about Season Two. Bruce, why don't you take it away and get the show started.
Bruce Mau 02:06
Thanks, Jason. Thanks, Bisi. Really excited to be joining you today. You know, talk about big minds. I really enjoyed the whole season. Chris Bevolo said that design is the synthesis of science and the art of the possible. Congressman Paul Ryan said that the right needs to accept universal health coverage and the left needs to accept that the private sector will be involved. Dr. Gita Vaid talked about how psychedelic medications could be a powerful low cost tool for confronting chronic mental illness. The show seems to be doing what you set out to do, imagining new ways of thinking about health and health care. Are you starting to see any common threads between guest visions now that you've completed two seasons of the show?
Jason Helgerson 02:54
Great question to kick us off here Bruce. I think that Season 2, just to talk about maybe where it's a little bit different than Season 1, I definitely think we had more guests who focused on very specific areas. Yes, we had some guests who took a broad look at overall health care and health generation, but this season we had more guests who really, with laser-like focus, went into certain aspects of it which I think really helped round out when you look across the two seasons. But I do think there's some common themes.
I think personalized was something that jumped to mind. I think a lot of our guests were very optimistic about the idea that not only technology but the systems of health and health care will evolve to allow a much more personalized and less cookie cutter approach where we all get the same level of treatment and that we could potentially get a more respectful, more humane, more personalized, a type of care that will lead to better outcomes, lower cost. And then lastly, I would say somewhat to my surprise, this season's guests, not nearly as bullish on the role technology will play in the future as I may tend to be. Definitely our guests see the human to human interactions being still front and center in healthcare delivery in 2049. And so those were just a couple of the key threads that I see going through the entire season.
Bisi Williams 04:33
And I would echo that. I did see that there was more consideration for personalization, but real human connection. I also noticed that while they were bullish on technology, they were really struggling with technology as it relates to complex problems and a wider range. The more specialized the issue, they could see that you would be able to actually hone in on conditions or preventative treatments using AI etc, but for general population health, I find it kind of interesting that the more basic, the more difficult it seems to be for data collection. So that was interesting. I also noticed that people were looking at this more from a consumer lens and certainly not only a more consumer-facing lens, but more, how can we be in this together from physicians and payers, so more of a mode of thinking about ways of co-creation, I think it was a little different, less top down.
Bruce Mau 05:45
Very interesting, so all in all, are you more or less optimistic about the future of health and health care now that we're two years closer to 2049?
Bisi Williams 05:55
So I'm more optimistic than ever. I think what we're learning from our guests is that the future is not that far off, that there are so many things that we can do today that would be almost revolutionary, if you will, that it brings the future quite close to us. Jason, what do you think?
Jason Helgerson 06:12
I agree. Thinking back and Bruce you had, I think one of the great quotes from the Paul Ryan conversation about what's possible. I think unfortunately in the United States health care has become such a political issue that really divides more than it unites. But certainly the Paul Ryan conversation gives me a lot more optimism about potentially crossing that political chasm to allow for a positive movement in the future. So that gives me greater hope and excitement for the future.
There's a number of the guests this season who I think gave not only compelling visions, but actually some very specific examples of what the healthcare system could look like. I remember Paul Mears, who is from Wales talking about, and we've also had a lot of other guests talking about the lack of integration and the inability of the various aspects of the system to be able to work together. There's a lot of wonderful, amazing things happening in Wales where they've integrated their health and social care systems, and are able to tackle really complex societal problems in really innovative ways because of that integration. I'm also optimistic because there's people out there doing amazing things that can be replicated elsewhere.
Bisi Williams 07:35
You know I have to agree, when I think about the Paul Mears and Bruce Piasecki talking about short termism, and how we have to get to long-term thinking, and couple that with Erin Venza about brain health and just how our resources are kind of finite even though we talk about abundance, but that restorative reciprocal way of looking at the whole person and the community around purpose, around their whole lives and then I also circle back to your your mentor, Dr. Kindig who talks about the alleviation of poverty essentially just to get the benchmarks for society higher by getting rid of the polarization and the politicization of care. So that was really kind of interesting.
Bruce Mau 08:24
So what did the insurance companies learn from listening to this season?
Jason Helgerson 08:30
It's a great question. In fact, I would say looking ahead to Season Three, I think we need to get more insurance executives on the show. Although I do point out that one of our guests this season, Ron Williams, is the former CEO of Aetna, one of the largest health insurance companies in the United States. I think he provided a really compelling vision for the future. What I thought was interesting is that he talked about how health care would be more personalized, the technology would open the door to that, but he also talked about it becoming more globalized, and that if the pandemic has taught us anything, what happens in Wuhan, China matters tremendously everywhere else in the world. We need to see healthcare as a global challenge and not just stopping at the water's edge in terms of national borders.
So I do think we've got Ron's compelling vision for the future can maybe help insurance executives, but I do think that one of the challenges that we're going to be facing, and if I was a purchaser of healthcare services as a Medicaid Director, you see all these innovative new things coming, new procedures, new treatments, and you worry about will this just bring more costs or ultimately these payers will have to pay for or will these new approaches, new treatments bring about the possibility of substantially better outcomes either at the same cost or maybe at lower costs. And I hope that the insurers listening today are walking away more optimistic about how to answer that question.
Bisi Williams 10:11
You know, just picking up on that, Ron Williams said something that I thought was really interesting, that this is a great time to be alive and to think of all the innovations and for a professional in this sphere, to think of all the new technologies that you can apply, or the new therapies that will make us whole and well. Paul Ryan also said the same thing. They're talking about setting up a Royal Blue Commission, I think he would call it, where you have all the best minds and all the stakeholders look at the ethics of all of these things. Like, what does it mean in our society? Who gets it? How do we distribute it? And how do we make it more fair? Or if fair's not the word, Paul Ryan talks about a fully funded system, as did Ron Williams indirectly and deciding what care will be available?
We know we're going to care for people. The question is, how are we going to design that care, and we can design it globally in a more ethically, morally and holistic fashion. So I was quite bullish on that, as well. But the question that I want to ask you, Jason, around the insurers and you being a purchaser, Chris Bevolo said when we're looking about the redesign of our health system, that you should look to those who have the most money. In the American situation, it's Medicare that has the most money, and his feeling was that the redesign actually isn't with the patient or the individual. But perhaps that Medicare can actually reimagine and redesign the future that we want to deliver this value-based care. I'm curious about your thoughts about that?
Jason Helgerson 11:53
Yeah, I think Medicare, as the largest purchaser of healthcare services in the United States can and has driven substantial changes in the system in the past. So for instance, the current system that is widely used in fee-for-service for how hospitals are paid was implemented as a result of Medicare adopting that particular payment policy, and every other purchaser adopted it. So Medicare is the most powerful driver of change. But I would say is that while the purchaser has power, and has influence, it is not infinite in the sense that you still need providers, organizations, individuals, entrepreneurs on the other side of that new financial incentive to innovate, to change, to bring new thoughts, technologies to the table to provide care in fundamentally different ways. So I think Medicare can and needs to do more, and I think recently it's actually done some positive things, it's not in and of itself going to change how health care is provided at the point of care. We also need innovation in the response to new financial incentives and that's only going to come from the folks who are on the frontlines of the healthcare system, thinking about providing care in fundamentally different ways.
Bisi Williams 13:23
That reminds me of something that Dr. Bella Krieger said, everyone thinks that the payer is the devil, and everyone seems to be in lawsuits with them. But she's thinking that now that they're sitting down together and figuring out, well, how can we make our life better for our patients and how can we make the offers more attractive to clinicians? She said something interesting and I'd love to hear your thoughts on this just as a specific innovation, she said that emergency medicine doctors hold the key to whether they admit someone or not. So getting them involved in value-based care is extremely important. What are your thoughts on that?
Jason Helgerson 14:05
Well, I'm an evangelical preacher when it comes to value-based care and so as you know, that's basically the core of what my consulting firm does is help providers negotiate those value-based contracts. I'm absolutely 100% believer that the adversarial relationship between insurance companies and providers is a direct response to the financial incentives created by fee-for-service health care, that insurers see providers as having a financial incentive to just provide evermore units of care whether they're effective, whether they're duplicative, whether they're fraudulent, because the more that they provide, the more they get paid and the better off they are financially.
Providers see the insurers as harassing them with paperwork and denying important services to their patients and just generally making their lives miserable, and hoarding the money all at the same time. And this, as I say, relationship between the purchases of health care in the American system and the providers is adversarial because of those financial incentives.
The key with value-based payment is to get them all on the same page to make healthcare a team sport. As I say, I'm an evangelical preacher, when it comes to value-based contracting, but it's a means but not an end. This is where we need fundamentally different ways of providing services. We need to think about different types of services that are really getting at the root cause of why someone is constantly in the emergency room all the time. We need to go upstream and figure out what's causing that and address it. But unless we're willing to innovate at the point of care where we could change the financial incentives, if there isn't innovation as a result of that, things aren't fundamentally going to change. So that's why I'm really excited about some of the guests that we had who really brought some interesting ideas to the table about how we can provide care in a very different way.
Bisi Williams 16:10
I agree. One question that I have for you, Jason, and Bruce, by the way you can jump in on here, too, is something that from a consulting perspective from where I'm looking at it, from a design perspective, that struck me as really interesting and something that is worth pursuing. Chris Bevolo talked about of the Fortune 500 companies that are focused on health,, like CVS and United Healthcare, but also in this space, Amazon, Apple, and Walmart, really looking at innovations with customer engagements where you build the best relationships from the first hello, looking at it from a wellness perspective. And if you run the numbers, you recognize that they're going to take the cream of the crop of healthy people, and leave the sicker ones to be down the road to be looked after by hospitals, and so on. I'm just curious from your perspective, don't you think that hospitals would want to get in that game where you catch the people when they're well and happy and whole and healthy?
Jason Helgerson 17:14
Yeah. So I think that you're starting to see hospitals' supremacy really being at a local level beginning to be challenged. Organizations with access to outside finance coming to the fore, and really going after some of the services, margin and revenue that these hospital systems have sort of enjoyed almost on a monopolistic basis. And that's really challenging the hospitals to begin to think about how they provide services differently, how they relate to their communities, how do they begin to engage individuals, instead of just providing sick care how they engage individuals in overall wellness and providing more than just, hey, come call us when you're sick, and a level of engagement that is not what we see in other sectors between people who sell services and the people who purchase those services.
So I think this competition, these new entrants into the health and wellness space is actually welcome in my view. I think that the predominant sick care system in the United States needed to be challenged and wasn't going to really reform itself. And so as a result, the entrance of whether it's Amazon just recently buying One Medical, a publicly traded primary care focused group that works with large employers as well as has in and of itself. Iora, if we remember from Season One with Dr. Rushika Fernandopulle, his company was purchased by One Medical and now One Medical has been purchased by Amazon, it's going to be very interesting to see what Amazon does with this new acquisition. Do they go aggressively into health care, into primary care, into Medicare? Do they leverage their resources, expertise in user experience to provide a fundamentally new model? Or is this as some are suggesting maybe a little bit of a dabbling in the space but not necessarily a major commitment? But they're not alone. I mean, we're certainly seeing some other major steps by the organizations that you're talking about.
My personal view is that I welcome the competition, but I'm not holding my breath waiting for Amazon to redesign American healthcare. I am a believer that companies that are either new, young today, or are even yet to be imagined will actually be the dominant players by 2049, that they will eventually eclipse hospital systems and in offering a different set of services, a better user experience because I think that to me is really the opportunity here is as consumers, we're all used to a pretty bad user experience in health care. I think people who can figure out how to do it really well are going to win, and people are going to vote with their feet. And so people are still trying to figure this out. But I do think between now and 2049, it will get figured out. And I think that the overall structure and who has control and power and influence in American healthcare will actually be quite different.
Bruce Mau 20:24
So that brings me to one of my last questions, which is, what about the health care consumer? What is the takeaway from this season that they can take home and get to work on right away?
Bisi Williams 20:38
I know our show is about optimism, but there was one cautionary tale. One of the things I love is if you can take a problem and turn that smile upside down, or turn that frown the other way around, there was something about the politicization of health care. And a number of our guests touched on it. Chris Bevolo went a little deeper. This actually got my design brain pricking. He put them into three groups. The mainstreamers, those who just go with the status quo and accepted medical practice; the progressives who use Western medicine mixed with other wisdom traditions of the East, etc, and a more holistic, more spiritual kind of medicine; and the contrarians who actually just fight the medical establishment.
I'm thinking, those are design problems that we can get in front of right now to put trust in the system as we rebuild it to think about there's room in the basket for a number of different methodologies. I think that as we move to the future we think about network systems, and all the different knowledge traditions to get to healing and wellness. So in that sense, I feel that empowering the consumer or the patient, or that the customer should know that those other choices are available to them. And I think that practitioners can get in line with that as well to kind of open their mind a little bit to evidence-based practices from other wisdom traditions.
Jason Helgerson 22:19
I agree with you 100% and I would go one step further. I think at the end of the day, the most likely path to that better future in health care, one where we end up with a more efficient, more effective system of care that's more personalized, that's more focused on outcomes, that's more efficient, is really through the consumer. And that an empowered, supported knowledgeable consumer who frankly expects more from the system is to me the best pathway forward. I am more optimistic about the consumer than I am about purchasers or I am about providers in terms of their ability to really transform the system at scale. And that empowered consumers who understand there are more choices out there.
One of the key moments for me in Season Two was Dr. Gita Vaid talking about psychedelic medications to treat mental illness. And as you were referencing, sometimes these alternative treatments are by the medical establishment, pushed to the side, treated as sort of quackery and dismissed out of hand. And I think we need to embrace, sticking to the evidence, but I think there has to be willingness to try and explore and be open to alternative ideas. I think consumers then need to be given choices in terms of where they want to go for their care more so than today.
My hope for health care consumers who listen to our show is that this opens their eyes, that there are alternative ways to get care. It's not just the hospital down the street. Going back to Season One, if you're a transgender person who feels like the healthcare system has completely turned their back on or has no understanding of what your situation is, and is incapable of meeting your needs, there's a website, you can go to called Plume, which has doctors that specialize in transgender health care who understand your needs and can provide you with access to the services you need and want in a very thoughtful and empathetic fashion. To me, that's just one example of the future state of health care that could be one that's very personalized, very tailored, that offers individuals, regardless of where they are, what their needs are, or how they want to live their lives, can offer them care that in fact fundamentally meets its needs. But I think the key to that will be to empower the consumer, to excite the consumer to encourage them to demand better from the healthcare system.
Bisi Williams 25:14
You're right. And I think just to add on that, Ashlee Wisdom of Health In Her HUE, talking about people's lived experiences. And Dr. Norma Padron, also, when you're talking about the Hispanic community, and using technology and population health, and just making sure that the voices are heard. And so like you I'm bullish, and I think that these alternative services will likely not be so alternative, they'll just be the natural way that I think that people will go about looking after their health and well-being and that, as a community will be more attuned, sensitive to the different needs. As we learned in Season One, there's no such thing as standard and that's a notion that I think that people are becoming more and more comfortable with, and that there are variations on a theme.
Jason Helgerson 26:08
I actually wanted to ask a question of both of you, which is really looking forward to Season Three. What voices have we not yet heard that we need to tap? Whether it’s their perspective, their ideas, their profession? Do you see any specific areas that we should focus on for that upcoming season, and maybe Bruce, I'll turn to you to start
Bruce Mau 26:31
We just recently published a book with Dean Julio Ottino at Northwestern School of Engineering. The book is called The Nexus and it's on the intersection of art, science and technology, and the new kind of practice that is emerging at the intersection of those domains. I really believe that the kind of value and the problem solving and the capacity to deal with the complexity of health care is going to happen at that place. Because what you want is all of the capacity of science and all the potential of technology, but you want all of humanity and the empathy and the compassion of art. And if you think about that kind of combination, it's a really extraordinary new kind of practice. So finding those practitioners, the Nexus thinkers, the Nexus people, I think, would be a great place to start for Season Three.
Bisi Williams 27:40
I couldn't agree more, I think that that is the holy grail of systems thinking that we're looking for. And that would be just a wonderful game changer for the health and related fields and more granularly, I was also thinking life scientists and ethicists, would be really great to have them walk us through what's possible when you look at the GRIN technologies of genetics, robotics, information, and nanotech, and what that actually means for our health and well-being moving forward.
Jason Helgerson 28:16
I agree, the only things I would add are, I'm particularly interested how the physical space of health care is going to change and actually is changing already, in how we design from an architectural standpoint, the hospitals, clinics and other settings of the future, obviously, a lot of focus on digital virtual services, but we're still going to need these bricks and mortar locations. I think there's a lot of interesting opportunities and thinking out there about what those facilities should look like.
Also investors, a tremendous amount of outside capital is now flowing into the healthcare sector, generating some debate as to whether or not we should welcome that outside investment. Or we should be doing things to prevent it from happening. But I think the investor's perspective is really going to be crucial, particularly in American healthcare, but I think it's going to actually be something of importance worldwide, so getting an investor perspective would be very good.
Then lastly, is international. I think we've done a pretty good job of getting individuals from various parts of the world. Obviously, Paul Mears from Wales we talked about earlier, but I do think there's even more interesting innovative things being done. And back to Ron Williams point, which I agree with 100% is, I think health care will become more globalized in the future, meaning that we won't be simply as American say for instance, dismissing any innovations that happen in other parts of the world, but that it will become more like say pharmaceuticals where drugs are developed in one part of the world and quickly criss crossed to others. I think that we will see that in other aspects of our healthcare system and so more international voices will be the case and be of interest. So with that Bisi and Bruce, I guess we'll have to leave it there. Bisi, it has certainly been a pleasure, I've enjoyed this season and I look forward to next.
Bisi Williams 30:18
Jason, it's always a pleasure to collaborate with you and I really enjoyed this season as well. A hearty thank you to Bruce Mau for moderating our show today.
Bruce Mau 30:27
Thank you and congratulations to both of you on a great season and a great show. I look forward to next season.
