Ep 76: The New Health Economy: For Women Leaders

[00:00:18] Ceci Connolly: Well, hello, Her Story fans. We have got a really special podcast for you today because it is one of my fellow co-hosts, now turning the tables on Sanjula Jain to talk a bit about a new book that she has coauthored. And it has got the perfect title of “The New Health Economy: Ground Rules for Leaders”. And we know that we have healthcare leaders tuned in to the Her Story podcast regularly. So this is a great opportunity to get a little bit of the headlines out of the book and hopefully you’ll all be purchasing it soon. But let me say welcome to my fellow Her Story co-host, Sanjula. Great to have you with us.

[00:01:04] Sanjula Jain, Ph.D.: Thanks, Stacy, this is fun to do this together.

[00:01:06] Ceci Connolly: It sure is. And we are super excited about the book. I certainly know from experience that writing books are a major undertaking and pretty much a labor of love, unless maybe you’re a Danielle Steele or somebody like that. So why don’t you tell our audience a little bit as to why you undertook this with, I’ve got to say, full disclosure, two of my good buddies, Gary Bisbee and Don Trigg. I’m sure many in our audience know them ,have worked with them over the years. Don of course spent a lot of years here in Washington, DC with me in the political world before going on to Cerner and doing a lot of their international work. And then finally President of that international company, of course. Gary Bisbee from Health Management Academy for many years. And now one of our major supporters at Her Story and creators of Her Story. So you decided to do this book, the three of you. Tell me why.

[00:02:09] Dr. Sanjula Jain: Well, Ceci, I wish there was like a methodical answer to that. Really, it was over a cocktail conversation a couple of years ago when, to your point, Don’s got this great background at this intersection of technology and politics and policy, and Gary and I have our respective backgrounds. And so, over the years we’ve worked together and worked a lot with health systems and industry partners. I come from the academic world, so I’m used to teaching in public health schools. And so we would on oCeciasion, every time we got together, would just be chit chatting about conversations we were having with leaders like yourself in the industry. And we were already doing a lot of writing in our own independent channels. So I was writing a newsletter, Gary had a blog, Don was doing some writing in his channels. And so it was just kind of this spitballing of, huh, what if we just joined forces? We’re already doing all this writing kind of in silos. Maybe there’s an opportunity to kind of combine our thinking and put together one framework that would kind of reinforce a lot of the things that we were writing for our respective audiences. And so at the time Ceci, as you know what it takes to write a book, we had no idea what we were doing or what it would involve. And we were certainly not authors. We had full-time jobs, but it was really, we felt like it was our way to give back to healthcare just because we were so deep in it. All three of us spend a lot of time on the road working with a lot of different organizations and leaders. And so we were just hearing all these things and it was constantly, like, do you have an archive of things you’ve been writing? What are some common themes? What are the frameworks? And I personally was spending a lot of time writing about healthcare trends and presenting on it. So it kind of proved itself to be a great opportunity to kind of say, okay, well maybe let’s take a step back, go back to basics, put together a framework that brings in some of these foundational principles that we think guide how all of us have to be thinking about healthcare. And the last piece of context I’ll share is timing. So we started this conversation actually in late 2019 believe it or not. So before COVID. It was early into early 2020 and we were thinking about the 10 year anniversary of the ACA. So this project really originally was born out of how do we kind of put together a compilationn of the last 10 years of healthcare. And then COVID happened that we can talk more about that process and how the project evolved, but that’s really the why was just, how do we combine our thinking, combine our experiences to put together a framework to help people just have a sense of the background of healthcare.

[00:04:38] Ceci Connolly: So obviously there are so many healthcare books out there. Often they have something like, here are the problems with healthcare and here are the proposed solutions. We’ve all read and studied many of them over the years. What would you say are the really unique aspects to your take on today’s healthcare? And I am intrigued that you target it very intentionally in the title to leaders.

[00:05:06] Dr. Sanjula Jain: So probably a couple things. One is I’ll start with where you ended on the leadership part. The three of us, our entire careers have been spent working with both experienced leaders from the C-suite on to kind of a lot of where I spent my time in the classroom, right, with aspiring leaders and individuals who are pursuing degree programs in medicine and public health and business who wanted to go make an impact and aspire to do what you do Ceci. And so, there was kind of this gap of, well, where do you start, right? We have a lot of people come in to healthcare who don’t have a foundation of healthcare, right? You can’t teach this stuff overnight and it’s so complicated. And so the second piece was we took the vantage point of the four Ps, right? Politics, policy, provider networks, and data-driven personalization. And so I think a lot of books out there really go deep on one of those types of verticals. There’s a lot of healthcare consumer books or healthcare policy books. And we said, it’s an ambitious undertaking, we recognize that, but how do we give aspiring and current leaders a starting point that brings a little bit of that intersectional thinking so they have a primer on really all of those kind of key sectors of healthcare, because ultimately you can’t be an effective leader if you’re running a health system and you have no context of what folks on the Hill are talking about and vice versa. And then the last differentiator, and this was kind of my favorite part, is, coming from academia, I think this book really bridges the gap between industry and academia, right? It’s kind of not just a traditional historical textbook, but it’s really from the voice of leaders in the industry. So the book has a lot of case studies from CEOs of large organizations. So we’ve got CEOs of Pfizer and J&J. We’ve got your other good friend, Nancy-Ann DeParle, who’s one of the architects of the ACA. So we have these leaders who have lived it, and have been living it, and then went through COVID. And so we’ve kind of brought this firsthand perspective so that, no matter who you are, you can really get inside what it’s like to be a leader in healthcare and how do you navigate the complexity of the industry and think about the four Ps and then what does that mean going forward?

[00:07:20] Ceci Connolly: I want to come back to those four P’s, especially because Her Story does focus a lot on women leaders in healthcare and leadership, and those are so central. But before I do, just the other portion of the book title, “The New Health Economy”, when you all settled on “New Health Economy”, what are the components in your mind? And are we already in it or are we heading towards it?

[00:07:46] Dr. Sanjula Jain: That’s a great question. So I’ll take us a step back. First, why the health economy is a framework, right? Because a lot of us are so used to thinking about the healthcare industry or ecosystem. These are a lot of the words that we typically use. And so the starting point for us is we felt like, back to the intersectional thinking, at the end of the day, healthcare is a large part of our global economy and domestic economy. And so we wanted folks to really think about the magnitude of, the government is the largest payer and regulator, and providers and payers have all big piece of this, and consumers are actively making choices, and Walmart and the new entrants are coming in. So this is basically a $4 trillion dollar economy and the implications of everything in the book and these concepts are things that we have to broaden our lens to be thinking about because, historically, I think, I won’t speak for everyone, but certain sub sectors of the industry have been a little bit more narrow focused in their scope and healthcare has now become so much more interdisciplinary. And COVID accelerated that as we think about the public health implications. So health economy, just to get people to really think about the bigger picture. I’m also biased because I’m a health economist by training. So I think a lot about supply and demand. And the same thing. We tend to focus on, okay, is it just consumerism? Is it the provider part? What are the macro economic factors that come from government and other forces, other exogenous factors that might influence how all of us have to operate that are beyond our control within a particular organization. So we wanted to really put that out in the water table. And then to your specific question, I think we are in the process of getting there, right? I think we’re finally at this point where folks are realizing, wow, this is a bigger endeavor. There’s a lot more pieces to the equation. And so if I’m trying to make meaningful change in whatever respective area of healthcare I’m focused on, I have to think about all these pieces of the equation. But are we fully there yet? I mean, as you know, change in healthcare, it’s slow and it’s incremental and it takes a long time. And so I think we’ve seen a lot of progress over the last few years. COVID certainly catalyzed kind of the timeline for some of that. But I think we’re still, not that I think there is an end point, but I think we’re looking at a lot of these changes really taking hold over the next decade in terms of really getting to that new era of thinking.

[00:10:08] Ceci Connolly: So let’s go back a little bit to the four Ps and that is the heart and soul of this book. And maybe also a related question, which is, how did the three of you collaborate on this book and were one of you more expert in one of the Ps, and how’d you kind of divide it all up?

[00:10:27] Dr. Sanjula Jain: It was an evolving process, let me tell you that, on our weekend Saturday and Sunday morning Zoom calls, and we’re like, okay, how do we go up about this? The way the book is laid out, it’s basically three chapters for each P. And so the mental model was, okay, the first chapter is a little bit like the before COVID historical context. And that was inspired by the famous Churchill quote, like the farther back you look the further ahead you can see. So we felt like this foundation, we got to give people a starting point for, if we’re talking about the future of health reform and policy changes, well what happened with the ACA? And what happened before the ACA with Hillarycare? And even before that. So you have a sense of what the incremental changes have been, what worked, what didn’t. So we’re not reinventing the wheel. We can kind of pick up where we left off. So the first chapter in each P really gives that landscape and it’s more of a longitudinal view. The second chapter is more of the kind of during COVID framework. And that’s where the case studies are. So let’s hear from leaders across different organizations, different rules of how they’re thinking about that P and the intersection of the other forces of change. So if you’re Nancy-Ann and you’re thinking about policy, what are the other payer and person dynamics that you have to be thinking about? So you kind of get that firsthand perspective. And then the third chapter is really, okay, so now that you have that context, how do we think about that going forward? And so, within that, how we divided it originally, we said, okay, well, Don, you have more of a politics background. So maybe you want to take the entire politics P and write all three chapters. And in the end we were very disciplined about all three of us would outline every chapter together. So we would outline the Ps together. What are the key points we want to hit? And then it ended up emerging into, we just kind of evenly spread it. So for the politics P, Don spent a lot of time doing more of the background in chapter one just because that was context that he had lived in being in DC with folks like yourself, Ceci. And so, could Gary and I have written that? Sure, but probably not to the level of depth that Don could just crank out, versus on the provider network side, Gary has a long history in the health system world. And so he took the first crack at that. On some of the personalization stuff Don and I shared that. So it was a little bit of a mix and match and the case studies, maybe one of us would start outlining it and then the next one would go add comments to it, and then the third one would go edit it. And so I wish it was easy to say, okay, three of us divided up each P and then we split a P, but it was kind of an evolving process. But we were all consistent about talking about it, editing together, updating it. And then at the very end, once we had drafted everything, we had to go back, print it all. out and make sure the voices and the language, we weren’t being redundant, was kind of harmonized because it’s really hard to write with multiple authors. We each have different writing styles. So that was probably the trickiest part.

[00:13:32] Ceci Connolly: Yeah, it’s interesting. On that final note, I certainly know all my years at the Washington Post, if there was a story that was dowble by-lines, typically one person took the lead writing just because, again, we were doing it all in very quick turnaround and that was most often the method. So it’s interesting to hear the way the three of you kind of put it together. I also have to say, as a recovering journalist, it warms my heart to hear you mention outlines. And so that’s a great segue to talk a little bit about writing and I’m sure there are many Her Story listeners and viewers that are thinking to themselves, well, I’m in healthcare. I’m a Chief Medical Officer. I’m a data analyst. Whatever your role might be in healthcare or the one that you aspire to, and you may be thinking to yourself, I’m not a writer. I don’t write. My job, isn’t writing. And again, I will share my bias. I think that most of the writing in the business world is atrocious. Granted, I do have high standards. But friends, Her Story listeners out there, please, you must be able to communicate, and not necessarily to write a book, but how about a decent memo that’s going to go to a board of directors, for instance, or a public official. So with my little soapbox tirade here, Sanjula, why don’t you talk a little bit about your thinking on the writing process. Why outlines? What other tips do you offer folks?

[00:15:11] Dr. Sanjula Jain: It’s you know, it’s interesting you say th,at Ceci because personally, I don’t even identify really as a writer, right? It’s not like I chose a profession where this is something I aspire to do. And never in a million years did I envision that I’d be a part of a book project, right? And so to your point, it’s such an important vehicle for how we communicate in this industry, whether it’s to boards, or it’s externally, or from a thought leadership perspective. And so the best advice that I ever got back in graduate school when working on my dissertation was to chunk it up, right, which sounds obvious and intuitive, but it’s really hard to be disciplined about that. And so my advisor at the time would say, well, every morning, first thing before you get into your day, spend 30 minutes or 15 minutes, and you have to write a paragraph or write or bullet out a couple of points, whatever it is, get those thoughts going so you’re consistently working on it because writing projects are an evolution, as you know, right? You’ve got the idea. You want to outline some thoughts. But then, as you’re thinking about it, you have conversations, you’re going to refine it. And so getting something on paper was usually the starting point. And so our process, collectively, we would verbally outline it. And it was interesting. Don was more of a written on his notebook. I also like to write it out, but given the three of us were working virtually in three different cities, someone had to sit down and actually document it on a Word file and then share it around. And so I think outlining is, even if you don’t stick to the outline, it gives you all a starting point to figure out the scope because, especially with this project, we learned policy, for example. You could go really expansive on the kind of background on what is the Affordable Care Act, what is the medical loss ratio and how do you define it, and what’s the right balance of footnote? And so it came back to our audience. And the challenge is our audience is pretty diverse. So we’ve got the established executive who’s been in healthcare for many years and probably knows what MLR is like the back of their hand. But the students that I’m teaching don’t know what that is, right? But it’s also not meant to be a pure textbook. And so what’s the right balance of detail that you need to get into? And so the outlines were really helpful for us to say, okay, we want to make sure that we cover these points. And then as we start writing it, then we would probably write more and then we would chop towards the end. And it would be an iteration and we track changes and we did a lot of, when we could get together in person, we would actually print out a section together and we would read it verbally and we would sit in a room and we would make comments. And sometimes the process of actually reading it out loud and talking it through together, we would say, well, we’re missing this point or, hey, students might want to know this versus a CEO might want to know this. Do we want to make that addition or do we not? So that was the big picture process. Personally as you know I also do a lot of weekly writing with more of a research analysis that I publish outside of the book. And so, I work better under pressure. And so giving deadlines, knowing that I’ve got to put something out every Sunday, means that, by Friday, there’s gotta be something done and the team needs time to be able to upload it and be able to distribute it. And so I’m a morning writer. And so I know that about myself. And so I know that, if I don’t do it first thing in the morning, even if I block out time in the afternoon, I’m never going to be as productive. So don’t even try to go down that route. So I think it’s a lot of reflection and figuring out what works. And each of us had different styles throughout the process, but we had to be really clear with each other about what works for each of us. And so Gary’s very linear. He’s a more structured outliner that even I am. And so it, what’s the level of detail that everyone needed to be able to then go off and do their pieces? And then we come back to the outlines and say, okay, we missed this point. Do we still need this point? Did we already talk about this point in this section? Do we need to come back to it here? So it got messy in the middle, as you can imagine, right? Everyone tries to make it very linear and you think, okay, if I do this, this, and this, it’s going to happen. Then in the end, you’re like, oh, I’m gonna move this around. And even the chapter format, to your point, we said, before COVID, during COVID, after COVID. And then we went through a bunch of rounds where we said, well, maybe we should, like, before COVID for each P in one section and then do their encode for each P. And so even those structural discussions and conceptually, we spent a lot of time teasing that out and moving chapters around and I would take sticky notes and I would actually like put them on my desk and say, well, if we’ve talked about it here, how would this change the order here? So we’re all different in our processes. I don’t know if that was any insightful advice, but I think it’s, start small is really where I would start. A book endeavor is a big task, but whether it’s from social media writing, if it’s a memo writing, it’s PowerPoint writing, it’s a blog writing, start small. Who’s your audience? What’s the message you want to get out? Outline that. Put something on paper. It’s not going to be perfect the first time. Get someone to give you feedback on it, talk it out, and then keep iterating. The perfect is the enemy of good, as we all know. And so I’m a big believer of, just get anything and everything out there. And when I’m doing my literature reviews, I do long documents just to get my thoughts there and then I’ll start refining and typing. So there’s no formulas but you probably have better advice than I do.

[00:20:39] Ceci Connolly: No, I think you’re certainly hitting on a number that come to mind for me as well. I think of an outline as your roadmap and if you don’t know where you’re going, it’s going to be a heck of a journey, right? And your mention about writing every day. This goes way back to my time at the Poynter Institute. And I still have on my bulletin board right above me a phrase in Latin that they gave us, “nulla dies sine linea”, which is “never a day without a line”. And the point is to write something every day. I will say that most of the time when people ask me, I am interested in writing a book, what’s your advice? Typically the first thing I say is, write a magazine article because, to your point about starting small, often a magazine article is all you’ve got to say. And there’s no need to go longer. But it’s also a good way to kind of exercise that writing muscle and to figure out if it’s something for you to do regularly, I suppose. So let’s just talk a little bit more about, for our leaders and aspiring leaders here, especially the women. Her Story, we always like to focus on successful and rising women in healthcare. Are there one or two things that you would really want to flag in this book for that audience?

[00:22:11] Dr. Sanjula Jain: I think a lot of it from a personal development perspective is, you and I have heard on the show in a lot of the interviews that we’ve conducted, it’s so common for us as women leaders to doubt our expertise, right? I can’t go apply for a job at a pharma company if I’ve spent my entire career in the provider industry, right? And we hear a lot of that time and time again. And so I think this book, for me personally, is a reminder that you don’t have to know everything about healthcare, right? You don’t have to be a healthcare expert. In fact, it’s really hard to be a healthcare expert because it’s a really complicated industry. And so it’s a balance of breadth and depth. And so I think this book is a primer to give whoever you are, wherever you are in your career, whatever you think your background is. You could say that you have zero healthcare background. I was talking to a founder yesterday who decided to enter the mental health startup space and knows nothing about healthcare, right? But doesn’t stop her from solving the problem and she’s going to do great things. And so this book is, for someone on that end of the continuum, okay, give me the quick rundown of, what’s the language? What’s the narrative? What are people talking about? If I need to go deep on MA plans, I could go figure it out, right? You can go look that up. But you don’t need to go into that role or go into an opportunity discussion knowing everything that you think you need to know. I think it’s more of a reminder to our audience that, if you ever doubt yourself or feel like you need to know all these things, you don’t. You’ll figure it out as you move along. But, to the extent that it gives you comfort, I think this book is a great starting point, whether you’ve got no context, or even if you are a CEO in the provider world and you’re making a career jump to venture capital and investing, right? I think there’s something in there for everyone. And I think, even as I’ve re-read it, I went through my own kind of career pivots in the last couple of years through the process of the book, and I have a different appreciation of different sections because I’m thinking more about tech and data more than I did when I first started the project when I was more on the health system side. And so I think it’s a little bit of an evergreen reminder of what’s happening in the world of Pfizer and J&J and what does that mean if I’m trying to enter the health system world or vice versa. So that’s how I would view it as just, you don’t have to know everything and hopefully it’s a reminder that, even the book, we didn’t cover everything, and there’s no way to cover everything. It’s so expensive and the knowledge or industry, and what’s changing changes every day, right? Every hour, there’s some new update. And so if you get the framework, if you get the foundation, and you have a little bit of historical context, then the rest you can figure it out as you go. And so I’m hopeful. I’m hopeful that this is a tool for female leaders in particular, but all leaders to say, if I just orient on the principles, the rest I can figure out how to apply to my unique situation.

[00:25:14] Ceci Connolly: And so I’m curious and I ask this of a lot of the leaders in healthcare these days. I’m curious if you are more optimistic or pessimistic about the future of healthcare in the United States.

[00:25:31] Dr. Sanjula Jain: I would say I’m actually optimistic because, back to our emphasis on leaders, I think it’s more about, we have the right people to make these changes happen. It’s just a lot of the historical nuance of how we’ve operated as an industry, back to your earlier question about, are we there yet? Are we fully in that new health economy? And so we’re starting to see some of those non-traditional collaborations take foot, right? There’s a lot more people from policy sitting at the table with big tech and startup growth stage companies and health system leaders, right? Before, that was, not that it didn’t happen, it wasn’t as commonplace. And so I think we’re starting to see more of this intersectional thinking and collaboration, and I know you and I are both spending a lot of time in telehealth, for example, right? A couple of years ago, I would argue that that conversation on telehealth was probably more concentrated to the telehealth providers and maybe a couple of policy makers. Now, every stakeholder in the health economy is talking about telehealth and that’s great. And that’s why it gives me optimism that if, you have all the players at the table and all of those perspectives represented, you’re going to get to solutions much more effectively and faster. We’re going to start making that incremental progress because, what do we all complain about? It’s like, oh, we need to do this. But then the incentives aren’t matched up. And so how do we talk to payers about that? Or how do we implement it down to the patient level? Oh, we got to work with the health system. Well, if we’re starting and bringing everyone together, I think we’re going to start seeing more of that. And so that’s really our message to all of our leaders is, you all are experts in your respective areas and you have a wealth of experience and knowledge. Now, how do we just bring it all together so we’re learning from each other and moving faster and more strategically on whatever initiative we’re trying to tackle?

[00:27:22] Ceci Connolly: Yeah, absolutely. And I appreciate you mentioning payers because, if I were to add a fifth P, it would probably be health plans. But often people forget that healthcare is also such a highly regulated industry. It’s highly personal. It’s highly regulated. There is so much money that the complexity of it all, did you think much about to what level you wanted to simplify some of this complexity in your book?

[00:27:52] Dr. Sanjula Jain: Yeah. So actually, something I want to come back to that you just mentioned because I think it’s important to this simplification is this framework of the four Ps, we actually debated pretty heavily. Do we call out a P for payers? Do we call out a P for pharma or med device? And one of the reasons we didn’t do that was back to this intersectional point. You framed it really beautifully as the connective between all these pieces. And so we talk a lot in policy because government is the largest payer and, whether you’re MA or you’re a commercial plan, you have to be in touch with what’s happening there. We talk a lot about how payment is policy, and so a lot of these incentive structures, they all go hand in hand. And provider networks was a really intentional term because, as you know, and this is a lot of your world, there was a lot more convergence of provider sponsored health plans and health providers wanting to learn more about payer expertise and vice versa. So we’re calling that more of a provider network. And so, to your specific question about simplification is, we were intentional to say we’re going to almost introduce new terminology because how you think about payers or life sciences or value-based payment, we’re not going to have chapter titles or sections on those discrete topics. We’re really trying to show that all those issues, all those stakeholders, all those topics that we’re all trying to solve, you have to think about it from this four Ps lens. And you’ll kind of inherently get through all those questions you should be thinking about. And so I think that was our way of trying to simplify it because it was like, well, otherwise, then we’ll get down rabbit holes of, okay, how do we go tackle value-based payment? Is it a policy issue? Is it the consumer issue? What’s the consumer’s role in affordability? It’s like, okay, well, everything we’re trying to tackle, or each of us from whatever vantage points we’re operating from, should actually methodically go through, what are the series of questions that we should be thinking about that are considering the impact of all the policy forces at play, right? All the provider network forces at play. And that’s why we have the ground rules for leaders, because we’re not giving solutions. The three of us knoq a lot of that healthcare, but we certainly don’t know all the answers. That’s what our leaders know, right? But we’re trying to give these principles. Well, if you know healthcare is political, well, that is a dynamic that we all have to operate and lead within. So how do we prepare our boards and how do we have these conversations with our management teams to say, okay, well, what do I need to do differently? Or what do I need to factor in my conversations or into our strategic plan, that accounts for that dynamic, regardless of who you ar?. So it’s really a framework to guide thinking and decision-making more than anything as opposed to, here’s the roadmap for how you go fix healthcare.

[00:30:45] Ceci Connolly: Well, I got to say it is really exciting that the three of you have tackled this undertaking because I do know it’s an undertaking, especially in the midst of a pandemic and all of the other things. As you mentioned, many of our Her Story regulars juggle multiple things personal and professional. And I know a lot of the women leaders out there in healthcare, they almost have sort of a portfolio of activities that they’re doing. And so this is a terrific addition to your portfolio, Sanjula, to now have a great book published. We are going to encourage everybody to go out and buy “The New Health Economy”. Friends, please support our Her Story buddies. And also I hope you follow me and Sanjula and Her Story on Twitter, because it would be a great place to kind of keep this dialogue going live in real time. So with that, Sanjula, thank you so much for the great conversation.

[00:31:47] Dr. Sanjula Jain: Thank you Ceci. This has been great.