Dr. Natalie Landman, Executive Director, Center for Healthcare Delivery & Policy, Arizona State University
Why should we design a healthcare model with personal accountability at the center? Dr. Natalie Landman, Executive Director at the ASU Center for Healthcare Delivery and Policy, shares a vision of sustainable solutions and tools that empower patients and healthcare providers to work together to achieve optimum health outcomes.
Dr. Natalie Landman is the Executive Director at the ASU Center for Healthcare Delivery and Policy. Natalie manages the portfolio of center projects, including project definition, launch, and implementation, as well as serving as a liaison to academic, private, government, and non-profit entities in support of the center's mission. Prior to joining the center, she served as Associate Director of the Research Strategy Group in the Office of Knowledge Enterprise Development at ASU, where she was responsible for the identification and development of large-scale research initiatives, and the establishment and promotion of collaborations with clinical and corporate partners. Natalie joined ASU after nearly three years at McKinsey & Company, where she served numerous clients in the healthcare and high-tech sectors on a range of strategic topics. Natalie holds a PhD in Neurobiology and Behavior from Columbia University in New York City.
Show Notes
Dr. Natalie Landman shares her experience in academic research, health policy, economics, and the healthcare delivery system. [03:30]
A vision of the empowered patient and physician working together to create the right set of treatments for the best health outcomes. [05:40]
We need to teach people that they impact their own health. [07:36]
Four websites that share vital hospital information and assist people in making beneficial healthcare decisions. [08:05]
An example of how the Ministry of Health in Singapore discloses health care costs with full transparency prior to the patient’s procedure. [10:43]
Health care should be a right, but people have to have skin in the game. [13:35]
How can we bring health care costs down by 2049? [16:24]
What costs do health insurance really cover? [18:20]
An explanation of how health insurance in the US allows for inefficiencies in the system. [20:02]
The benefit of universal healthcare coverage. [22:53]
What’s wrong with employer-based health insurance? [23:30]
How does employer-based health insurance affect the job marketplace? [25:04]
The four fundamental things people look for in health insurance. [27:56]
How can we design a healthcare model with personal accountability at the center? [29:21]
How can we incentivize physicians? [30:20]
How can we incentivize health insurance providers? [31:07]
A fascinating example of how salsa music helped a patient with dialysis–a cheap solution to an expensive problem. [32:34]
The one thing that Dr. Natalie Landman doesn’t want to happen in 2049. [35:25]
Transcript
Bisi Williams: I'm Bisi Williams, you're listening to health 2049.
Natalie Landman: I really wanted to take the perspective of the patient because I feel like in a lot of the discussions that we have around healthcare, the patient is often talked about as this third entity out there somewhere, but we're all patients sooner or later. And so I think my vision is really having that dyad. The empowered patient and empowered physician working together to create the right set of circumstances, the right set of treatments, et cetera, so that the patient ends up with the best outcome for them.
Bisi Williams: [01:33] Let's agree, the United States of America undeniably provides some of the best healthcare in the world and is one of the most innovative nations. The financial investments in health and medical research are the envy of all. And yet there is no such thing as a single unified and coordinated US healthcare system, but rather a complicated and fragmented healthcare marketplace.
My guest today is a firm believer that knowledge is power. She will share her vision for an empowered citizen, working with empowered healthcare providers to achieve optimum health outcomes for each individual. Natalie Landman holds a PhD in neurobiology and behavior from Columbia University. As a researcher, she led a biotech company with technology platforms in Alzheimer's disease and oncology. She's a health economist with deep understanding of the entire medical delivery system from bench research to bedside care. Currently, my guest is executive director at the Arizona State University Center for Healthcare Delivery and Policy.
She is responsible for the design and implementation of its vision, for a sustainable US health care delivery system that provides high value healthcare for all citizens. Her job is to describe, promote and facilitate the realization of a high value health care delivery. Welcome to the show Professor Landman.
Natalie Landman: [03:11] Thank you again, Bisi for a very, very kind introduction. And thank you for having me on the show today. I'm very excited about our conversation.
Bisi Williams: [03:19] You're welcome and we're glad to have you. Professor Landman, you seem like a unicorn to me. Could you briefly explain your expertise and academic research, health, economics, and health care delivery?
Natalie Landman: [03:30] So I started out as a research scientist, trained in the discovery and development of novel therapeutics for Alzheimer's disease with an extension in toxicology at a later point. When I was finishing up my PhD, I felt increasingly frustrated by the 17 year timeline from bench to bedside and was looking for an opportunity to have more immediate impact.
On patients and patient care and got interested in healthcare consulting was lucky enough to get into a large consulting firm and spend the next three years working with a variety of healthcare delivery organizations, helping them understand their patient populations and hopefully optimize the care for that patient population. Eventually my husband and I decided that it was time to consolidate operations and he had been at the university for quite some time. So I decided to see if I could find an opportunity to combine both my research background and now my consulting slash business background into a what turned out to be kind of an ideal position.
So for the past 10 years, I have been working at Arizona State University with the former executive team of the Mayo clinic and our work kind of falls into three buckets. We teach health, economics, health policy, we do health policy research. And then we also have kind of a pro bono consulting arm where we work with a variety of health care delivery organizations, helping them redesign the care again for the patient population that they serve. So it's been a really, really neat opportunity to get involved across the whole spectrum in healthcare.
Bisi Wiliams: [05:14] So given the fact that you can see everything from soup to nuts, let's just say, in the healthcare ecology system, tell us about your vision for health and wellness in 2049.
Natalie Landman: [05:27] You know, when you first posed the question to me about 2049, I thought about myself and how old I would be then, and I will be 70 years old. So you guys can figure out how old I am.
Bisi Williams: [05:38] I'm bad at math.
Natalie Landman: [05:40] But I really wanted to take the perspective of the patient because I feel like in a lot of the discussions that we have around healthcare and about healthcare. The patient is often talked about as this third entity out there somewhere, but we're all patients sooner or later. And so I really got to thinking about what kind of care do I want for myself at 70 and for my family. And what I want to see and what I think is feasible, especially with the growing recognition of how much impact we have on our own health as individuals. The growing number of tools that are out there whether it’s wearables, just information on the web, in home lab tests and so on and so forth, I think we really have an opportunity to empower patients to be the stewards of their own health.
I also think we have the opportunity to empower physicians with more information about their patients. And about what other providers around the country and around the world know about specific conditions and about specific patients and populations.
And so I think my vision is really having that dyad of the empowered patient and the empowered physician working together to create the right set of circumstances, the right set of treatments, et cetera, so that the patient ends up with the best outcome for them. Because an average patient doesn't exist. We're all unique, we all have our differences, challenges, genetics, socioeconomic circumstances, et cetera. So it's really about taking all of those things together and coming to a shared vision, sorry for stealing that term, but really shared a shared vision for that patient.
Bisi Williams: [07:28] That's amazing. So how will you achieve your vision of this dyad or some of the practical things that would need to happen?
Natalie Landman: [07:36] So I think one is just a general sense of awareness. I think we need to start teaching people that they have a lot of impact on their own health. I think we need to provide them with the tools to make decisions about their health and their healthcare. I think a lot of those tools are actually available already in sort of pockets around the country and around the world.
Bisi Williams: [08:01] For example, could you tell us some of those tools that are available?
Natalie Landman: [08:05] Sure so a lot of good tools to support patients in their healthcare decisions are already available, either around the country or around the world. Now, some patients are simply not aware of them while others don't necessarily have access to them. And of course the tools themselves could stand to be improved upon, but we do have somewhere to start.
One of the things that happened over the past decade or so, is the center for Medicare and Medicaid services started putting out information about the value of different hospitals provide. It's called the Medicare Hospital Compare, it's a website. You can go there, you can type in the name of a particular facility that you are considering, or even several facilities.
I've had conversations with friends who were looking and trying to compare two or three different healthcare facilities for their care because their physician had privileges in each. And so Hospital Compare is one place you can go to take a look and see how different hospitals in your area, or even other parts of the country compare on certain measures on things like complications, things like mortality rates, even at this point on their cost of care. So that's one website.
Health Grades is another great website where you can go for information about specific facilities and even specific physicians and look at both quantitative comparison. So this is actually data coming in from Medicare and other states on how these hospitals do in different types of conditions.
And for the physicians, you can actually get some patient reviews about how well they have done on X, Y, and Z dimensions. And I'll mention one more, the Rand Institute in California has also created almost like a value calculator, if you wish. Now it's primarily based on Medicare data, but it's better than nothing. It's a good place to start where it allows you to set, they have several leavers in the calculator that allows you to set your priorities. Is it more important for you that the care is safe? Is it more important for you that it's effective? Is it more important for you that it's timely, et cetera, to help you figure out based on your needs and your preferences, where the best place for care might be?
Bisi Williams: [10:25] Those are three fascinating examples of which I didn't know about at all. Those are fascinating resources that we can use today. How do you imagine in 2049 is that we could improve the communication of what doctors are measuring and what patients are measuring?
Natalie Landman: [10:43] I think first we need to consolidate some of this information into one place. And I know there are arguments about which of these different sites, and there are others like Leapfrog. There are different kinds of rating agencies for healthcare. We could just at least consolidate them in one place and give folks the opportunity to choose for themselves, what’s most important, but at least all the information will be in one area rather than disparate across the web.
Bisi Williams: [11:15] I love that. And I love that you actually are designing the experience, right? You have parameters from which the consumer can choose, which is also very empowering, clarify some of that. Could you talk a little bit about, from your position, do you think that transparency is an achievable goal in terms of patient-physician communication?
Natalie Landman: [11:40] I believe so. And the reason I believe that is because I know that it exists in some countries and also here again in some areas. So one example that comes to mind is what happens in Singapore. The Ministry of Health actually published this information about the cost of care for various procedures at various facilities. You can actually go to the website today, type in, let's say, I'm having an appendix removed or some other common procedure and it will populate a table for you with a list of hospitals and the cost associated with that particular procedure.
In addition, this was absolutely fascinating to me, and I wish we would have that here. I think with some will, we can, they will actually counsel you in advance of a procedure about what the cost of care is going to be, how much you actually have in your health savings account to pay for the procedure so that there is full transparency around the experience.
Bisi Williams: [12:42] That sounds really quite empowering for the patient, the things that you have control over, you can decide who, where and when, and how much you're going to pay. And so when we address the challenges of healthcare and systems, there's some very painful points that we need to address. Would you agree?
Natalie Landman: [13:07] I think I would call them pain points rather than painful points. And I would look at them as challenges and opportunities, rather than sources of pain, per se. There are plenty of solutions. I think there needs to be a will to actually make them work.
Bisi Williams: [13:26] I think that's amazing. And then I have another question for you ,and your vision in the year 2049, is healthcare privilege or a right?
Natalie Landman: [13:35] I think it should be a right, but people have to have some skin in the game.
Bisi Williams: [13:42] Tell me more about how people will have skin in the game.
Natalie Landman: [13:45] If we're looking at sort of all of the determinants of health, of an individual or a population, healthcare delivery, so the actual care that you would receive when you show up in a physician's office or in a hospital, that has a relatively small contribution to your overall health.
There are different models out there, some say that it's about 10%, if you include things like genetics. If you actually just look at “modifiable factors,” because we're not yet there with, genetic engineering, but if you look at the modifiable factors, which are things like behavior, socioeconomic circumstances, healthcare education, et cetera. Healthcare, again, still plays a relatively small role. I think the biggest I've seen was about 20% of the total. And so again, when we look at the other brackets, we have socioeconomic circumstances, education, and then behavior.
Now, they're all intertwined to some extent, but behavior is a big one. And I think we all know what we need to do to stay healthy. Eat the right foods, get some physical activity, not drink too much, et cetera, not smoke, wear seatbelts, et cetera, et cetera, but not all of us do that. And frankly, I'm guilty of it myself from time to time, for example, not eating well. And so I think that, while it is a right, I think there still has to be some sense of personal responsibility that's baked into whatever healthcare system we design. You know, you need to have people say, I am in charge of my health, I know what I can do, I know I can contribute. And so different countries again, have done that in different ways.
Singapore, again, to go back to them, they’re a very interesting model. They actually have a mandatory health savings account that's taken out of your paycheck on a regular basis and the way they set things up, you still have to contribute to your own healthcare expenses. Now the government provides a significant subsidy, but there's still that piece of your skin in the game you have to contribute. And so it puts a little bit of the responsibility on the patient to actually proactively try to stay healthy because they know that some of the money is going to be coming out of their pocket if they get sick.
Bisi Williams: [16:11] That sounds interesting. So let's talk about the price problem today and what are three or four things that we could do to mitigate the price problem for the year 2049.
Natalie Landman: [16:24] So again, transparency, I think would be hugely important. It would be very, very useful if we look at other areas of healthcare that are “consumer driven,” like LASIK surgery, some types of cosmetic surgery, it's all out there. The information about prices is out there. The information about quality of care is out there. And people shop around and they force the providers into a price range that they will accept.
Another interesting example was done by the state of California by CalPERS, which is the state pension fund. They did, what's called a reference price. So they said you are part of our system as a patient. Here is how much we are willing to pay for, say, a knee replacement. Now you as a patient have the choice. You can go to the providers that offer it for less, offer it for that, or offer it for more. If you go to the providers that offer it for more, you have to pay the difference out of pocket. So let's say they set the price that we're going to pay $30,000 for orthopedic surgery. You're welcome to go to the hospital, it charges $35k, but you're going to pay the $5,000 out of pocket. What do you think happened? So that was an interesting thing, right? Not all the patients decided that were going to go to the hospital that charged the $30,000, some decided to go to the more expensive facilities. But what was interesting is that, the price started dropping because there was transparency and choice.
Bisi Williams: [17:57] I mean, that's fascinating. I mean, that seems like a good capitalist model. A good exchange of goods and services with no middle person in between. So that's interesting. When we look at that, can you give other examples, like, for example, is health insurance as we understand it in the United States a bit of a paradox?
Natalie Landman: [18:20] I think we have forgotten a little bit about what insurance normally is for. Insurance in other areas, whether it's home insurance, car insurance, et cetera, is really done for catastrophic events. Whereas in healthcare, we have come to this expectation that if we're getting health insurance, it has to cover everything. Both catastrophic coverage, as well as all the primary care, and sort of preventative care, et cetera, anything that doesn't land you in the hospital. That would be the equivalent of maybe trying to get home insurance for your appliances or for an oil change for a car. I don't know anybody who gets insurance for oil changes. Again, for things that are kind of regular maintenance. And yet in healthcare we've come to expect that insurance has to cover everything from A to Z.
And I have seen people have very generous insurance coverage, use it because it's there, whether or not they need it. Whether or not the care they're getting is providing any additional value. And so I think there's an opportunity to rethink a little bit the way we structure our health insurance marketplace and the types of plans people can have access to. And frankly, I would be fine if we had a variety of plans and there are folks that really want to coverage A to Z. They can get it. I believe we should have choice.
Bisi Williams: [19:48] I love that you draw between an oil change and a car accident in terms of insurance. Though some people are imagining in the future that there'll be some sort of universal care. Is that something that you entertain?
Natalie Landman: [20:02] Absolutely. I think we absolutely should have universal coverage.
Bisi Williams: [20:06] What does universal coverage mean to you?
Natalie Landman: [20:09] So I would say we need to have everybody in the same scheme. So the US is unique, we have, our insurance is in series. And I’ll explain what I mean by that. So in most countries in the world, health insurance coverage is provided kind of birth to death. Whether you look at the UK, whether you look at Singapore, whether you look at the Netherlands. You name it. It's everybody in the same system, birth to death. Now the types of insurances they go through might change, but everybody's in the same boat.
What we have in the U S is a fascinating accident of history. But what we have is we have private insurance for folks who are young and working, and then we have Medicare for folks over age 65. And so we have private insurance that gets all the healthy folks. And then the government or the taxpayer gets everybody when they're sort of over the hump and are starting to have all these different health issues.
Because if you think about it, if you look at healthcare spending or how much healthcare utilization folks have throughout their life, the majority of it happens toward the end of life. And so what happens is there is no incentive for the private insurers to really do a lot of prevention because they're not going to reap the financial benefits, which are going to come much later when folks are on government provided insurance. So the thought is, let me just get them until they're 65 and then they are the taxpayers problem. So why am I going to invest any money in prevention and health promotion when all the benefits are going to accrue later to the government.
Bisi Williams: [21:55] Wow. Okay. So how did you flip that model? What would be a better economic model?
Natalie Landman: [22:03] Well, I would say that we need to go again to the, to what everybody else is doing internationally. Just, we have to have everybody in the same scheme from birth to death. So everybody in the same set of insurance options, birth to death, not all the young folks in private coverage and all the elderly under government coverage. I think that sets up a bad precedent. And a bad set of incentives for the system to really concern itself with again, health and wellness
Bisi Williams: [22:32] The series, the way the system is currently designed now seems to me, that business model doesn't serve very many people at all. How do you imagine the economic model could shift without getting people feeling that you know, that it's a benefit or a right, it’s just good business?
Natalie Landman: [22:53] As I mentioned before, I think everybody has to be covered. So we need universal coverage. I think people should own their own insurance because one of the things that, I'm sorry, I know we said we're not going to talk about the pandemic, I'll just mention one thing briefly. But one of the things that we saw over the past year is that, because we rely so much on employer-based coverage for our healthcare, people were not only losing jobs, they were losing their healthcare and they're losing it in the midst of a pandemic, which is as absurd as it can get.
Bisi Williams: [23:25] That's insane. So that is a point in our system that we could design right now.
Natalie Landman: [23:30] Absolutely. I think, you know, what we have proposed is that everybody owns their own insurance. And if the employers want to contribute to it as a benefit and help you pay off part of the premium or all of the premium by all means, let them. But your health care coverage should not be dependent on who is employing you, whether you're employed or not. It should be yours. And you shouldn't have to worry about losing it because you moved, you changed jobs. You decided to leave the workplace.
There’s a whole slew of issues that come with the current system with our employer based coverage. One I've already mentioned, but there are others. I mean, when you move from job to job, there's no guarantee that your employer is going to have the same coverage as your previous one. And that they're going to have the same providers, healthcare providers, in their network that you had previously. So there's a break in continuity of care because you have to now find a new physician who doesn't know anything about you. You have to go through all of that process all over again, assuming that you can find somebody who actually takes new patients and so on and so forth. So it's terrible for a variety of reasons.
Bisi Williams: [24:44] Let me just interject here. So what I see here is that if everyone owned their own insurance, they would have, they'd be free. They'd have autonomy, in fact, they would be able to make better life choices for themselves and their family, both professionally, socially, and economically, if you had your own insurance.
Natalie Landman: [25:04] Absolutely. I think one of the other things that it creates right now is job blocks. So people are not leaving jobs that they may not be happy with because they have the benefits or they're not taking jobs that they really want because the insurance either isn't there, or it's not as good as their previous job. So it also creates a lot of inefficiency in the work, in the job marketplace.
Bisi Williams: [25:27] So I want to discuss this inefficiency because what you say is fascinating. So not only will you take control of your own health. You can take control of your finances and you can take control of your time. And when you think about 2049 and all of the technological advancements that we have, and all of the information that we have in terms of measurement, and we have this empowered citizen and empowered care provider. What do you think this means for productivity in terms of economic growth?
Natalie Landman: [26:00] I think there are tremendous opportunities, because again, I've mentioned that we are, we have a lot of inefficiencies in the job marketplace because people are tied to their insurance.
A typical employer will probably have three to five health insurance options. They may not necessarily be the options that you want, both from a coverage, as well as a financial standpoint. I may not want to have coverage from A to Z because I am healthy. My family is healthy. And so, I would prefer to be which I am on now on a high deductible plan with a health savings account that gives me choice of where to spend my funds, who to see and so on. That might not be available for me with a different employer than I have now.
Bisi Williams: [26:46] I think that's fascinating. Do you imagine that care will be beautiful? Will people be happy?
Natalie Landman: [26:53] I'm going to answer it as follows. There's no perfect healthcare system. It just doesn't exist. We've had the opportunity to work with folks in Japan, in the Netherlands, in the UK and Singapore. I've also had direct experience as a patient in Israel, in the Ukraine, obviously in the US, in Italy, there are always trade-offs. So that's point number one.
If you don't believe me, there was a survey done by the Commonwealth Fund, which is a quite famous think tank in Washington, DC, that a lot of folks quote. They did a survey of citizens in different countries that have different healthcare systems. And there's no way to make everybody happy. Out of 11 countries they surveyed, only four countries had about 50% of the interviewer’s say that they're happy with it.
Bisi Williams: [27:46] So what are the common things, on a basic fundamental level, for your health and wellbeing, do people look for universally?
Natalie Landman: [27:56] I think, again, having the comfort, so universal coverage, so knowing that if a catastrophic event were to occur, I am protected. I think having access to providers is fundamental. I think quality of care was important.
What was interesting, if you look at the four countries that came up on top, two of them were countries that had universal coverage through what folks call, a single-payer or something akin to it, and two countries were actually more of a market based system.
So my conclusion from all of that, and it was a conclusion that was also reached about 10 years ago by the OACD, which is the Organization for Economic Cooperation and Development, which is more of a global think tank was that there is no perfect system and that it's less the structure of the system than how it is managed. That's more important. That's key.
Bisi Williams: [28:59] So I think that's an interesting transition because one of the things I'd heard is that in order for this system to work, there needs to be accountability. And if you have a system, that means it's end to end design, how do you imagine that we would design governance models for health and wellness with accountability being key?
Natalie Landman: [29:21] So, I think again, we keep going back to the point of transparency. So I think we need on the provider side, I think we absolutely need transparency and accountability on both costs and outcomes. And again, we're doing some of it, but I think it could be done much better. And I hope by 2049, we can have that information at our fingertips.
I think the other thing, and that's again, something that's already going on on the patient side, some groups have gone out and changed health benefit design, in such a way, that if you as a patient, take good care of your health, you get a rebate on your health insurance at the end of the year.
Bisi Williams: [30:02] You could make money by being healthy.
Natalie Landman: [30:04] Exactly. I'd say that's a pretty good arrangement.
Bisi Williams: [30:09] I think, is that the behavioralist and the economist coming out in you?
Natalie Landman: [30:15] Yes.
Bisi Williams: [30:16] And so you can be rewarded.
Natalie Landman: [30:18] Yes.
Bisi Williams: [30:19] How could you reward physicians?
Natalie Landman: [30:20] In a similar manner I think, and again, that's something that's already being done in the country, in a bit of spotty and sporadic fashion. But if you, whether, it's being done both at the individual practice level, as well as, to some extent by the government, if you get good outcomes and you are efficient, you get a bonus. And if you don't. It kind of goes the other way.
Bisi Williams: [30:47] Well, I think that's fair. Right?
Natalie Landman: [30:49] Right.
Bisi Wiliams: [30:50] So, again, when we talk about incentives and bonuses, how could you imagine that the current state of insurers, what's their future state? How could they be a benefit to the citizens that they service?
Natalie Landman: [31:07] And so, maybe instead of spending time on things like claim processing and claim denial, you could have people actually reaching out proactively to patients that are insured under that company and checking up on them and saying, are you doing X, Y, and Z things? Have you followed up with your physician? Being of service and support of the patient to keep them healthy, to keep them active, et cetera. And there are some groups, again, this is what gives me hope for 2049, is that things are already happening.
Kaiser Permanente who happens to be both a provider and an insurer, so their incentives are aligned, proactively does this kind of outreach to their patients. They identify patients who are at high risk proactively. And reach out to them and provide them with services that will keep them healthy. Whether it'd be something like statins, which you know, are not cheap, but they are cheaper than having the person end up with a heart attack and in the hospital. And it's better for the patient, so everybody wins.
Bisi Williams: [32:18] I love the notion that everybody wins. Earlier you told me a story about a person who was having dialysis and it wasn't successful. Can you just tell that story of what was a problem and how it became successful?
Natalie Landman: [32:34] Sure. And I think this goes back to that notion of the dyad really of the patient and the provider deciding what's the best course of treatment, rather than having it be decided by some third party. Whoever that third party might be, whether it's insurers, whether it's regulators, et cetera.
The story went like this, there was a patient on dialysis, as you had pointed out, that was showing up in the emergency room on a pretty regular basis. I believe at least once a month, he would end up in the emergency room, they would kind of fix him up and then send him home. And the story would repeat all over again, about a month or a few weeks later.
Things changed when Iora Health got involved. They sent in a health coach into the patient's home to kind of see, what are all the other things, those social determinants of health or something else that could be contributing to his poor outcome and what the health coach discovered while she was there was that the patient also had an anxiety issue. And sometimes those panic attacks would happen while he was dialyzing at home. He would then pull out all of his tubes and of course crash because he wouldn't finish the dialysis and ended up in the emergency room.
Well, she inquired on whether or not he had panic attacks at other times and he said, yes. And she asked him, what does he do to manage them? And he said, I listen to music. And so their solution for this particular patient was to buy a used iPod and download some salsa music for him so that whenever he would dialyze, he would listen to the music. And from that point on, they said they hadn't seen him in the ED for at least six months, if not longer.
Now there is no billing code for used iPod and some iTunes that you could charge somebody for. The reason Iora was able to do that is because they are in a capitated arrangement where they get a per patient fee from the insurer that they work with. And they can do with that money whatever they want, to provide the best care for each patient. They have the flexibility to decide whether it is a new drug that the patient needs. Or, a used iPod or food delivery or whatever it is, that's preventing that patient from achieving their optimal outcomes, because sometimes it's not the healthcare piece. It’s everything else around it.
Bisi Williams: [35:06] I find that fascinating. And the question I have for you is, given all that's possible, what’s the one thing you don't want to see happen by design or accident in 2049?
Natalie Landman: [35:25] I think it's that notion of again, telling patients and providers, how care has to be done and what constitutes care. Having some, again, third party who isn't directly involved in that relationship between the patient and provider telling that dyad what the right answer is.
I think that's what worries me. And it worries me for a number of reasons I mentioned because there is no average patient because healthcare is not always healthcare, as we think of it. It is not always the right solution. And also because even if it is healthcare, medical practice changes all the time. And so, I don't want somebody being overly prescriptive of what needs to happen in a given patient physician situation.
Bisi Williams: [36:10] I mean, that's a relationship I think that we all would love. Right? Wow. That's been a fascinating discussion Professor Landman. And that wraps our show with Natalie Landman. Thanks for listening. If you enjoyed our show, please subscribe or share with a friend and until next time I'm Bisi Williams.
