Episode 66

Empowering Nurse Practitioners

with Sylvia Hastanan
Episode hosted by: Rishi Sikka, M.D.

April 25, 2023

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Sylvia Hastanan
CEO & Founder, Greater Good Health

Sylvia Hastanan is the CEO and founder of Greater Good Health; she has spent her career trying to “fix healthcare,” aiming to solve problems of rising costs and uneven quality. With almost two decades of healthcare experience, Sylvia brings her talent for marrying clinical and business operations to GGH, and translates that union into value.



Building a company from scratch is certainly something they don't teach in school.



Rishi Sikka, M.D.: Hi, I’m Rishi Sikka, co-host of Day Zero, and thrilled to be joined here today with Sylvia Hastanan, CEO, and founder of Greater Good Health, making a tremendous impact in the space of access and equity using advanced practitioners in healthcare. Sylvia, excited to have you here on Day Zero. Thank you so much for being.

Sylvia Hastanan: Yeah, thanks for having me.

Rishi Sikka, M.D.: Sylvia, I know we want to dive into the story on Greater Good Health, which as I’ve just mentioned is really one. Access and equity and fairness at its heart from a purpose perspective. And so much of that story and that purpose actually comes from your, your growing up and bringing that forward. I was hoping you could just share just a little bit about that with our listeners, just a little bit about the growing up, some of those experiences. Cause I think it’ll resonate when we talk later about greater good health.

Sylvia Hastanan: I grew up in a town outside of Los Angeles. Single mom from first generation from Asia. And it wasn’t all that easy. She was sandwich between generation. She was taking care of, and then generation she was raising here in the US and we saw our struggles with healthcare language barriers, cultural barriers. I always have wondered, Would I have known my grandmother or my great-grand longer if, we had better aspects and just knew how to navigate the system better. And that, that sense of fairness, equity, and just the right to healthcare always and embodied me and important throughout my career.

Rishi Sikka, M.D.: Thank you so much for sharing that, and I know that piece on healthcare actually is something you carried forward to probably. Your first sort of part of your professional journey, which was which was your education. Shout out to Penn, to Wharton

Sylvia Hastanan: don’t quake your.

Rishi Sikka, M.D.: And you have a unique background, both clinical, going to nursing school and going to Wharton. And I, I love the statement you had said to me earlier that very early on you decided in healthcare was important to follow the money. I just wanted to go deeper into that and how you approach your education and then actually some of your first career moves after.

Sylvia Hastanan: Sure. Yeah. At the risk of sounding like I knew it all back in, in the nineties, which I didn’t, I think I just saw a pattern of physicians going back to school and getting their mba. I’m not sure if physicians really knew why they were doing that either. But I think what we were seeing was just more of a business minded need around healthcare. That you couldn’t really just practice medicine. You really had to think about reinforc. Spread cycle patient acquisition and the livelihood of your practice and not just, just taking the folks to take care of good patients, which is what we want our clinicians to focus on. But it’s not the way it is. Healthcare is a business. And when I decided to go to Penn and do this program that sort of combined nursing and business principles, it just felt right for the time. And graduated and ended up just immersing myself in clinical operations, clinical strategy, and just looking at healthcare at a macro level.

Rishi Sikka, M.D.: Yeah. And you had them the opportunity to think about things on that broader scale and systematic changes in a senior role at Healthcare Partners. And, I love the elements that you had shared with me earlier about that you were in a spot in healthcare partners, an iconic organization with respect to value-based care. You were in an, in a spot where you were doing things that were innovative. So a startup piece to it, you were scale. And I also loved how you brought an academic sense to the work that you were doing in an academic mission almost or that academic rigor and hoping you could just actually talk a little bit about that healthcare partner’s experience.

Sylvia Hastanan: yes. I joined Healthcare Partners a long time ago back in oh seven. I joke that it was when, there weren’t commercially available risk gratification tools. There was no digital platform anything, right? There was barely any Bluetooth. We were still like clipping the Bluetooth speaker phones into the visor of our cars. I dunno if you remember that. They weren’t built into the cars yet. We were plugging in like really large Phillips scales into the phone. Jacks and the walls. It was like shooting up beta tech care manager, like in the internet. And we didn’t know familiar how that happened, but it was back when it was still pretty analog. And there weren’t a lot of these really cool. And now we see these innovations. There wasn’t a huge investor community behind value-based care and primary care delivery, health services, digital platforms, digital health. Let me see today. There what we had available to us were acade academic studies, so we went out to John Hopkins and up to o h ssu and study Eric Coleman transition model, Mary Naer transition model out of the hospital. And, just looked at what are people testing and experimenting with, and can we move from academia to commercial? And make it real and operational and scale it. And what did that mean in tweaking, the academic models are test in this nice protected, incubated conviction and it’s different in the real world. And when you’ve got, like payers and contracts and benefit design and limitations of resources. But that’s what we.

Rishi Sikka, M.D.: Yeah, that’s great. And we’re gonna see in just a few moments because, like you said, we never have our life planned out, but it’s gonna sound like a really clean story in a, in a. About how all of that is so important to greater good health, but before we get to greater good health, another iconic organization which you had a chance to be a part of, so you had the strategy and the operations and clinical piece, and then you went into capital allocation and worked with Optum Ventures and in Optum Ventures there, there were two realizations you had. Professional about, I think an opportunity in the market like so many of us, as we went through the pandemic and everything like that, there were also some personal reflections and hoping you could talk a little bit about both.

Sylvia Hastanan: Yeah, in the middle of the pandemic, it was 2020. I was coming off of my third maternity leave with my, my last daughter, Anna. And I was just thinking, if I was gonna go back to work, it was, all of us were thinking this, right? You’re gonna balance the time away from your family, the time away from the things we got accustomed to. The pandemic at home and making sure that what you were going back to was really valuable, impactful, and filled your cup. And I think I just paused like everyone else did and thought about it. I ended up leaving Optum and my role there at Optum Corporate and joined Optum Inventor for a few reasons. I’ve always been intrigued by, the startup world and the investor community. I participated in, some of light diligence here and there for funds who were looking for experts in the payer provider space. And I thought it would be a really unique opportunity to learn from one of the, one of the most interesting sort of healthcare oriented strategic funds. And so I joined OPT Mentors at their e i r, their executive and residents, and was exposed to a ton of different things. Loved working with the management team. At, within the portfolio companies that Austin mentors, but also learned a lot about investing. What valuations look like. I didn’t know the difference between a series A, a series B, and still arguably don’t have as much as the difference, but the but I think what I was seeing professionally was just a pattern that a lot of investors in Twitter in 20 20, 20 21, that a lot of investors were starting to invest in value-based. In the world I lived in, right? Like in taking risks on patients and financial risks on senior patients, managing their medical loss ratio building platforms, telehealth in-home programs, primary care solutions. And that was really exciting because it was a lot of the work I was doing in-house for big corporate companies, and to see that there was all this innovation and excitement investment. Out here in the world around innovating. And that space was really cool. And a and as I was advising these management teams, I noticed I was turning to the advice of using nurse practitioners a lot as as a resource to help, get in the home, to follow up on patient care plans and medication management or whatever it. And I turned to some folks like, somebody should really build a platform to get around this workforce that’s behind the way Modi overlooked and underutilized. And and wrap our arms around NPs, especially with all the tailwinds of state legislation changing the primary care shortage physician. Coming out of med school, the burnout and re retirement issue. We’re having and then this like influx of seniors who are aging into Medicare and choosing Medicare Advantage. And you kinda have to be careful, like when you point out these needs because then someone said, you’re it Sylvia. And and that’s how health essentially got started.

Rishi Sikka, M.D.: That’s great. And then you became it and that was the genesis of Greater so tell us about Greater Good Health. Tell us about what you’re doing and the impact you’re making. Both for, both for nurse practitioners and then both for the community in the market.

Sylvia Hastanan: Yeah, sure. So Greater Good Health was founded essentially to empower nurse practitioners. So we are a medical group and platform for NPs. We focus on primary care and seniors today. And we center on being the employee. We wanna be the employer of choice for nurse practitioners. So I think in the c I’ve had, in my career, I’ve worked for pre physician-centric organizations and have watched as we’ve used NPs to augment and supplement physicians in a practice, expand their panels and see more patients and provide better care. I think it’s time that NPs can come out from the way. From the shadows and really the primary care of record and some and states are allowing that to happen. And so what I do think is missing though, is thoughtfulness around their rewards, their professional development training around value-based care as culture and community that protect burnout, prevention. Isolation in the workplace and really level, blah, blah, nurse practitioner to work at top of license. And we and we work with at risk organizations, so we work with health plans, provider group enablement companies, and we help them manage their patients. And then we also have the cool opportunity that we’re building against this year to launch our own practices with nurse practitioners as primary care of record in a state that is allowing this with a national health plan in an MA product. And so we have three practices we’re preparing to open by fall of this year with NPs at the center of it, which we’re really excited.

Rishi Sikka, M.D.: As you look back on, on the journey a little bit in, in greater good. What were some of the things that surprised you were some of the things that you know you had to do or change with respect to your own personal growth, your development as a leader?

Sylvia Hastanan: Yeah. When when I came from a corporate environment, you don’t realize, but you’re almost playing this protected. Playpen of sorts, right? And then you come out of this type playpen and it’s like a different world. And what I mean by that is, is building a company from scratch is certainly something they don’t teach you in school. Certainly nothing that you, even at the biggest, best, most, most well capitalized companies out there you wouldn’t learn. And. That had been a real big learning curve for me. And also really rewarding going from nothing and then slowly building up infrastructure teams, people, culture, vision, inspiring people to follow you and building that up at a scalable pace. And so I think like the biggest piece of that build. Is pacing. That was the hardest thing for me was understanding like, you know what it, what it wants to look like at the end because we, I’ve worked there, I’ve worked at a really great Optum’s, a really great reputable company, and likely in my head I have an, I have an analog what that should look like. But I’m starting from ground zero. So how fast do I get there? What are the building blocks? Do I invest in this or this? And then when and who comes first, and so I think that pacing is probably the biggest learning piece I’d identify in the last couple of years. The other is just the the value of relationships that’s just been validated, completely in this whole process. Because when you think about building a company and a brand and a message from scratch, sure, I can convince you that there’s a need, there’s a demand, a supply issue, and we’re filling that need. But also I think like the relationships I’ve. And my team, comes with and has built and our reputations and, and our word and our experience and backgrounds all mean something. And so I knew this going into it, but it’s just really validating when you have nothing essentially behind you that your, that those relationships, your your personal brand really does matter.

Rishi Sikka, M.D.: We’ve got high inflation, we’ve got high interest rates unpredictable macroeconomic environment. Are we a nervous recession? Are we not nervous recession? How is this sort of a broader economic environment either affected how you lead or how you think, or how you’re think about key decisions for your organiz?

Sylvia Hastanan: Yeah, it’s challenging. Your question’s time. I think I, I’ll joke with that. I think I probably started this company Think Exacts Wrong Time. It was as the bubble was bursting around digital health, it was post covid. And I think there was a lot of investment in in digital health and primary care and in all this innovation, which was great to see as I had described. But I think. For seeing sort of the results that may be overin investing in some of those promises. And I raised at a time, my first round and then also this round I’m in now, during a time when, you know people are holding their first strings a little tighter, I think investors are looking for real companies to have real people real outcome. Fr product market fit and and have ex experienced management teams. Luckily we fit a lot of those. We check a lot of those boxes. But it’s not easy, cause folks are, we’re early and there’s a lot of things that we still have to prove. And and we are spending and we are spending money. We do have a burn and. Those are the tricky pieces is really finding investors who are convicted on the model and what we’re trying to solve for that. We’re the team to build against that and to change, to, to make huge changes and ways here. And luckily we have really great partners who are, building these practices with us and and deploying us in their infrastructure today. And so those names and relationships help us.

Rishi Sikka, M.D.: What can you share with our listeners are the next, 12 to 24 months of greater good health gonna bring for the organization, for burners practitioners, and for impact in the community?

Sylvia Hastanan: We still have a lot to build around being the community and employer of choice for nurse practitioner. That’s a big focus area. That’s, our institute, which is focused around learning and development. That’s the value across vision and all of the World War benefit programming was turn on professional development tracks and leadership and partnership programming, our culture and community. So those are all things that. We’ve just started to put the pieces together and to answer for what it is NPs are looking for in a fulfilling career in a great place to work. And so that’s gonna be a huge chunk of of the next 12 months, I’d say. We’re also really heads down in building our brand around primary care. And providing that expanded access to primary care in these communities where these clinics are gonna be live later this year. And so the innovation here that white, the white space here is like really thinking about what goes inside the primary care clinic. All the systems, the care teams and and resources that’ll make nurse practitioners thrive as primary care provider. NPs, as are used all the time in primary care pr, IC one today. Most of those ask in 2.0 primary care, startups are using nurse practitioners. And that care model redesign, that technology stack, the all the ins and outs and positive procedures and workflows around that are gonna be really. To figure out. And we’re headed down in the midst of that right now, head of open. But I think that’ll continue to evolve. We hope to get to that playbook where we have, that secret thought of what this should look like and then scale it so that in, especially in communities where, and we tend to be in communities, Physicians are not going back and practicing. So not South Florida, not Los Angeles, not New York, San Francisco, Chicago. But in these communities, these more tier two markets or mezzanine markets we call ’em, where there’s a real access issue and patients are rating six plus months to see of physicians, senior patients. Multiple chronic condition, poly and waiting that long to see a physician and so we, we think those are the markets that will be the best for us in terms of sick and we can provide more access to the patient and nurse practitioners will get level depth, and I suspect have more fulfilling careers as provider.

Rishi Sikka, M.D.: That is so tremendous what the future holds and a clear continuation of some of the earlier themes, not just from. From our conversation, but from your background about fairness, equity, and access and how you’re really making that real and supporting an entire community around them, if you could speak to your younger self. And there was one piece of advice or something you wish you could say earlier on when you were starting your career. What might that be? As you kinda look back at this sort of moment in, in what will certainly be a long and great and impact career.

Sylvia Hastanan: As my kids get older, I might repeat this to them, that don’t let people say no to you, and don’t let that, don’t let that stop you from doing what you think is right or where you want, what you wanna pursue. I think I was told no a lot, maybe not in a harmful way, my, my Asian Chinese mom saying you be a doctor, be a lawyer, and, growing up that way and and feeling okay to say that’s not the right path, I think I wanna do something else. And then in my career, I think a lot of, and really supportive leaders that I’ve learned a ton from. But then I’ve had some that you. We’re a little more stifling and and I think pushing through those things, I would’ve told myself to keep pushing through the no and those barriers a little harder than maybe I did as I was learning how to gain my own confidence and gain my own voice. If I got.

Rishi Sikka, M.D.: I am so excited about how your work around supporting a community and raising up their ability to practice to the top of their license, and then using that community to deliver. Fairness, equity, access to use your words from earlier in your background, in your career, in value-based care and to underserved communities. This is gonna be an awesome journey, and I can’t wait to hear what the next months and the next two years bring for you and greater good health. Sylvia, thank you so much for joining us here on Day Zero. Thank you for everything you’re doing.

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