Ep 10: When Data Becomes Personal

with Kaveh Safavi, M.D., J.D.

May 20, 2021

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Kaveh Safavi, M.D., J.D.
Senior Managing Director, Accenture

Kaveh Safavi, M.D., J.D., is a senior managing director at Accenture where he is responsible for leading, developing and driving a growth strategy that differentiates Accenture’s offerings for providers, health insurers, and public and private health systems across the globe.

A seasoned executive, Dr. Safavi brings more than three decades of leadership experience to Accenture Health. Prior to joining Accenture in 2011, Dr. Safavi led Cisco’s global healthcare practice. Before that he was chief medical officer of Thomson Reuters’ health business, vice president of medical affairs at United Healthcare, and had leadership roles at HealthSpring and Humana. Among his many accomplishments was establishing one of the Midwest’s first electronic-health-record-enabled primary care practices.

Dr. Safavi has published numerous papers and is often quoted on healthcare issues in various media publications, including The Wall Street Journal, the BBC, The New York Times, Consumer Reports, US News and World Report, Harvard Business Review and The Economist. Recently, IT Services Report named him the #1 healthcare IT executive for 2020.

Dr. Safavi earned an M.D. from Loyola University School of Medicine and a J.D. from DePaul University College of Law. He is board-certified in internal medicine and pediatrics and completed his medical residency at the University of Michigan Medical Center. He serves on the Weinberg College of Arts and Sciences’ Board of Visitors–Northwestern University, is a frequent guest scholar at the Stanford University Clinical Excellence Research Center and serves on the advisory committee of the Buck Institute for Research on Aging

[Leaders] have to have clarity about who owns what decisions, concepts of decision rights. Things really slow down if people don't know what decisions are theirs and what decisions or someone else's.

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Gary Bisbee  0:06

Healthcare leadership is hard work, but what if you could learn from the most brilliant and influential minds in healthcare and beyond? What would you ask them? Would you ask about politics, policy, or maybe leadership? On The Gary Bisbee Show, I’ll do just that. You’ll hear from healthcare’s most successful leaders and those experts who they listen to, as together we’ll explore how the healthcare economy is transforming.

Gary Bisbee  0:35

Dr. Kaveh Safavi is an exceptionally engaging and knowledgeable healthcare aficionado. As the Senior Managing Director and Head of the Global Healthcare Practice, I’ve always found Kaveh’s worldview to be incredibly useful. I asked Kaveh about advice for early-stage leaders, and he summarized as follows: become an expert listener, read extensively, and practice understanding where the individual is coming from. During our discussion about healthcare moving to a consumer or customer focus, Kaveh outlined his views of why we should be thinking about the person rather than the more transactional terms of “customer” and “consumer.” We dug into the personalization of healthcare and he observed that there are two arms of that dialogue: experiential and biological. Each arm is on a unique path and Kaveh shared the pace of change, challenges, and opportunities of each. Privacy is growing as a factor and Kaveh indicated that the US should be studying Europe and may have to catch up to Europe in the broader concept of data protection. We wrapped up with a very interesting conversation about how the large new entrance will need to proceed. We wrapped up with a very interesting discussion of how larger new entrance to healthcare will need to proceed. Let’s move down to the conversation with Dr. Kaveh Safavi.

Gary Bisbee  2:09

Good afternoon, Kaveh, and welcome.

 

Kaveh Safavi M.D.  2:11

Hi, Gary. Great to be here with you.

 

Gary Bisbee  2:14

We’re pleased to have you at the microphone. Kaveh, as you know, we’ve spent a lot of time thinking about leadership and lessons of leadership and so on. I’d love to ask you some questions about that, just to get your feeling. Why don’t we kick off with, looking back on your career, what have been the major leadership lessons you’ve learned?

 

Kaveh Safavi M.D.  2:34

They keep evolving. I don’t think I’m done yet, but I would say increasingly the value of understanding that you need to listen to understand, something that for me is a continuous work in progress. Another critical one is the idea that you have to teach people as opposed to telling people things because, if people understand why, it’s much easier for them to make decisions for themselves and to act. It’s also really important for a leader to role model the behaviors they are talking about. There is a “walk the walk” kind of aspect of leadership that’s pretty critical. Another thing I’m learning very clearly is that you have to have clarity about who owns what decisions, concepts of decision rights. Things really slow down if people don’t know what decisions are theirs and what decisions or someone else’s. That’s a good list of things I’ve learned over the last 40 years to start with.

 

Gary Bisbee  3:34

How would the young Kaveh have thought about leadership?

 

Kaveh Safavi M.D.  3:38

I wonder if the young Kaveh was probably a cross between young Sheldon and Alex Keaton, some version of that. I was an enthusiastic learner, but I wasn’t really driven by the goal of being in charge or telling people what to do, which led me to have a lot of curiosity and to ask a lot of questions. Sometimes that actually resulted in people saying, “Hey, you seem to talk a lot. Why don’t you take this over?” That was a valuable lesson I learned: if you speak up, you’re probably going to earn a position, which is positive or negative, but it didn’t come from a desire to be in control of anything. It came from a desire to learn and to participate. Listening before speaking has been a skill that I’ve evolved over time. My ratio of speaking to listening was inverted. More speaking, not enough listening early in my career. It’s rotating the other direction as I get older.

 

Gary Bisbee  4:33

You’ve mentioned listening several times. Are there any particular tricks or strategies you use to listen more or learn more from listening?

 

Kaveh Safavi M.D.  4:43

A few things. One of them is that it’s a conscious decision, it doesn’t come by accident, particularly if you’re playing a talk track in your head at the same time. You have to force yourself. The other one is the deliberate decision to not formulate a response until you fully understand where the other person is coming from, particularly in areas that you have a natural tendency to run ahead, so resisting that natural tendency and stopping to listen is important. It’s actually easier to listen in a field that you don’t know much about because you really don’t have anything to say so you’re in full absorption mode. It becomes much harder to have that kind of a conversation with someone where you know maybe as much or even more about a subject than they do, to be able to listen carefully. That’s part of it. The other part of it is, I’m spending more time seeking to understand where that person is coming from as opposed to what they’re saying. Another really important skill is recognizing that people’s perspective or point of view is often informed by their own personal sense of where they are in the world or what role they play, as well as some facts and whatever their orthodoxy might be. Trying to understand where they’re coming from and why exactly they’re taking this position or saying this is another important part of listening, and it means you have to listen through kind of the first order of conversation to the second order of conversations.

 

Gary Bisbee  6:08

Would you share with us a bit about your parents, and in particular, how they influenced your leadership style?

 

Kaveh Safavi M.D.  6:15

My parents had a huge influence on me. I was very lucky. Sometimes luck and the family you’re born into matters a lot. Both very intellectually curious, both scientific types. As a result, strong encouragement to understand complexity and nuance without oversimplifying things too much. They were both very optimistic, so the glass was, for the most part, half full. Both my mother and father, my father in particular, really encouraged debate. He encouraged rhetorical argument. His whole theory was that that would make us better thinkers. As a young child, this is an experience that I will never forget. As a very young child, it was Christmas and we were really excited about Santa Claus. My dad, beside my brother and I was a year younger, decided this was going to be a good time to learn a lesson so he immediately launched into a debate with us about why Santa Claus doesn’t exist in order to force us to make the argument about why Santa Claus existed. As soon as we got to a certain place, he reversed his position and made us argue the other side. Later in life, he told us how intentional he was about that. His whole theory was that we needed to understand how to make an argument and that he was gonna use this as an opportunity to teach us how to do that.

 

Gary Bisbee  7:42

That’s a great story. Just to wrap up this particular section, many of our audience are up-and-coming leaders, I would say, relatively early-stage leaders. What advice would you give somebody who’s at an earlier stage in their leading about leadership?

 

Kaveh Safavi M.D.  7:58

In addition to the things I talked about before, there are a few other things that really matter. You need to start trying to understand what’s important to you early on. That’s hard, and it evolves over time. For example, recognizing early on that title and positional authority wasn’t what motivated me. Intellectual curiosity motivated me more, helped me to make decisions about how I would approach certain things, maybe what kind of opportunities I would take. It would cause me to make career decisions, to take on things I wasn’t qualified to do because it was an opportunity to learn something that was interesting and curious. Another big one is the benefit of taking meetings and meeting with as many people as you can. There’s a natural tendency for people to focus on their task and everyone is coming at you. Particularly, you might be in a position where people want to sell you things all the time or people want to pitch you ideas. It’s easy to put up the protective shield and try to keep people out to do the work. I learned very early on, actually from my father. He was a scientist, but he was also a salesman. He was a gifted, natural salesman. This idea of interacting with people is pretty critical. I was on the opposite, which is anybody who wanted to meet with me, I figured out how to meet with them. I didn’t put any real filter up. I was genuinely interested, not for a transactional reason but because I was interested in getting to know people and I realized you can learn something from every conversation and from every person. You could also make a lot of professional friends, which turned out indirectly. If you follow Adam Grant, givers and takers, all this stuff pays itself forward in different ways, so that part of it was really important. Then the last one is the value of reading. From a superpower perspective, the thing that’s helped me be particularly successful is that I read a lot. As a result of that, my fact base is bigger than just listening to a conversation and repeating it. Over time, the value of reading has continuously been amplified, so I encourage people to find time to read, and you don’t have to read one domain. It really expands your thinking, so I put that on the list too.

 

Gary Bisbee  10:13

That’s great. Listening, reading, and understanding where the individual is coming from are three takeaways from what you’ve said, all of which are first class. Let’s move to what some are calling personalization in healthcare consumerization, putting the person at the center. Given your background as a physician and a lawyer, you know as well as anybody that we haven’t been very good at that in healthcare. What terms come to your mind? Do you use the term “customer” or “consumer” or “person?” How do you describe getting to the person at the center?

 

Kaveh Safavi M.D.  10:56

My colleagues at Accenture and I have actively moved away from using the language of “customer” or “consumer” for healthcare and focusing more on “people” or “person,” in part because “customer” or “consumer” has a relatively transactional notion to it. We’re trying to describe a relationship with a human being as opposed to a transaction. I go back to something that was really influential in my thinking about this. Probably 2004 or five at IHI, Don Berwick, gave a talk and he posed a rhetorical question, which is still fabulous. Don said that, when a physician visits a patient in a hospital, is the patient a guest in our facility? Are we a guest in the patient’s life? Who’s visiting who? If we’re guests in their lives, which is one way to think about it, are we being very good guests? The interesting thing is to convert the physical metaphor (you’re a patient in the bed) to the therapeutic metaphor, which is “I’m a guest in your life to help you, so I need to think about myself that way.” That is a really interesting distinction and, in some ways, a contradiction. The challenge has been that we’ve been caught up in the physical manifestation of that relationship, as opposed to the trust base manifestation of that relationship. It goes to your issue, Gary, which is that the narrative around person-centric and patient-centered care. I’m not sure it’s really been about putting the person at the center because, in my mind, if the person is at the center, then they’re in control of the interaction and they get to make the decisions about whether or not things happen or don’t happen. I would argue that a lot of what we do that in the name of being patient-centered is still provider-centered or delivery, system-centric. It’s just increasing levels of permission. It’s like me taking my dog out for a walk and giving the dog more leash to create the illusion that the dog is in control, but I’m still holding the leash and it’s still on the dog’s neck. That hasn’t been reversed. The truth of the matter is we’ve been giving patients more leash but we haven’t really given control over. However, a variety of forces in society, both the ability as well as the motivation, are all conspiring to reverse that polarity. Therein lies both a threat and opportunity.

 

Gary Bisbee  13:37

What do you think about data? In particular, there’s so much more data that individuals have now about themselves, their conditions, medical care, and so on that it’s putting them in a position where they are more able—if they want to—to make the decision or, if not make the decision, at least influence it. How do you think about that?

 

Kaveh Safavi M.D.  14:03

There are two separate arms to this. There’s an aspect of our recognition, the kind of Maslow’s Hierarchy that we all have a greater sense, that our desire to actualize ourselves in the healthcare experience is part of our psyche. The realization that people’s ability to know us and understand us is heightened creates expectation. Like, I would expect that you would be able to do a better job of personalizing this experience for me—but in no way, shape, or form are people giving up the right to have control over their own information—so the expectation is still that this is my information. It’s not your information, it’s my information. I’ll decide when and where you can use that information and my expectation is that you use it correctly. I don’t know if you saw the most recent Harvard Business Review, a really interesting article about how loyalty programs can backfire. The idea that I joined a loyalty program and now you have data about me and you do something that clearly demonstrates that you didn’t use it, that’s worse than not having a program at all right. There’s the same kind of issue here with the hospital. If I go to a health system where I’ve been going my whole life and they keep asking me the same questions, that’s worse than if I’d never been there before. They asked me those questions, so that expectation is there. Because we know the information, it is possible for that to happen. That being said, patients also recognize they won’t be able to make all the decisions for themselves and they are going to have to trust that delivery system. They’ll delegate certain kinds of tasks to the delivery system. I’m using the word “patient” because this is an actual ill person in a hospital bed. That person is a patient. They’re also a consumer and a citizen and a relative all at the same time and every one of those personas is simultaneously interacting, so they might be deeply deferential to the clinical staff around the lab tests but they have a totally different perspective around their ability to control their environment, which might include scheduling things and when they’re going to leave the room and who’s going to know if they’re in the room, all those sorts of things. You have to be cognizant of all that moving around at the same time.

 

Gary Bisbee  16:32

Let’s talk about the perception of illness for a moment. If you’re in a hospital bed, almost by definition, there’s going to be some decision that’s made that you really can’t make, you don’t have the capacity or the information to make them. But if you’re not at a hospital and you’re making a decision that you don’t perceive is really being that much affecting illness, then you’re probably more willing and interested in making that decision yourself. Does that make sense to you?

 

Kaveh Safavi M.D.  17:03

Yeah. From a framework perspective, you delegate certain decisions based on their complexity or your capacity, and everybody has a different point at which they make the decision. Some people will delegate to their clinician, some people will delegate to their relatives. Some people won’t delegate it all and we have to be cognizant of the fact that we as human beings all have a different way of thinking about that. It’s actually something I learned because I’m an internal medicine and pediatrics doc. It was fascinating to me early in my career to see the contrast, because internists basically just treat patients. It doesn’t make any sense because many of these patients don’t have the mental capacity to make the decisions, whereas pediatricians almost always treat families and parents as much as they treat children. As a pediatrician, I realized that I have a patient, which is the child, but I also have a patient’s family and every conversation included the family members. What was so interesting when I would make hospital rounds was that it didn’t matter, on the adult wards and even as an attending physician. Every day, after I saw a patient, I made sure I call whoever was the caregiver for that family member. I didn’t do it because I stopped and thought about it in some strategic consumer sort of a sense, it just felt like that’s a natural thing. I know that this 90-year-old person has somebody else who’s their caregiver who I need to have a conversation with because this person isn’t in a position to do that. It was fascinating to me how my peers, who didn’t have that similar training experience, didn’t have that as a natural conscious part of their consciousness.

 

Gary Bisbee  18:41

In industry, you’re increasingly seeing a position of Chief Customer Experience Officer, which we don’t see much in healthcare. Is that something that you think will become more popular in our health systems or possibly even health plans?

 

Kaveh Safavi M.D.  19:00

I’m seeing more larger organizations think about experience officers, some of them are taking a slightly different angle, a technology angle to thinking about digital. Some of them realize that, once you create that, it doesn’t make any sense because experience is everywhere, so I think we’re going through an organizational evolution where we’re trying to decide. This is really about adoption. If we’re going from not really having skills to having skills, there is the one organizational objective that you want it to be someone’s job until you realize it’s everyone’s job, but the evolution of that requires a certain level of attention. The best examples I find are leaders who come in realizing that their primary objective is to create capabilities and then to catalyze the diffusion of those capabilities into the organization, rather than to somehow be in control of a part of the business because there’s no logical way to reorganize around something like experience that needs to be present everywhere in every touchpoint.

 

Gary Bisbee  20:00

Drucker said, “A business purpose is to create a customer.” How do you think about that in relation to a large health system today?

 

Kaveh Safavi M.D.  20:09

That’s a fascinating question because one could argue that that narrative sort of works in healthcare and sort of doesn’t. At a competitive level, it makes sense because you’re trying to build loyalty, but there is also the broader notion that the purpose of the healthcare system (if we executed ourselves perfectly) is to not have customers because people would be able to care of themselves. Looking at the Mayo brothers at the founding of the Mayo Clinic, one of the concepts from one of the brothers was that the purpose of medicine was to eliminate the need for a doctor. His concept was that medical—essentially, given what doctors could do 125 years ago, which wasn’t much—a pill that could actually treat a condition was a way better answer than seeing a doctor who didn’t know what they were doing. Fast forward that today, and I think about if I wake up sick, or if my kids wake up sick, I don’t wake up and go, “What I want to do today more than anything is to see the healthcare system.” What I want to do is to be better. Now, if the path to being better requires me to go through a healthcare system, fantastic, but my goal isn’t to have a relationship with the healthcare system. My goal is to get to a clinical outcome, to get to a physical outcome, so we as healthcare providers need to recognize the fact that the long game is to minimize the amount of time people need to deal with us. However, we also want to be in a situation where, if someone needs care, we want to be the place they would prefer to go because of the nature of the experience and the nature of the quality of the outcomes they’re going to get, so we have to hold both of those concepts in our mind at the same time.

 

Gary Bisbee  21:53

Let’s turn for a moment to digitization and scientific innovation. We’ve seen a lot of increase since the high tech act in digitizing medical care, which’s having consequences to create substantially more data, both for the consumer and for the provider. How do you think about precision medicine and all the precision medicine strategies that collect enormous amounts of data around a particular condition? Are you thinking over the course of this decade that that’s going to make a difference in quality and the type of care that can be delivered?

 

Kaveh Safavi M.D.  22:38

There are two arms of that dialogue. There’s what I call the biological arm and then there’s the experiential arm. If you focus on the biological arm, lots of energy being put against, it feels like oncology, clearly evolving to a place where no two people with the same disease are treated the same way, especially as we understand how the interaction of the immune system with the underlying cellular drivers of cancer interact so that you have to understand that person in order to create therapy and other immune diseases or immune-mediated diseases increasingly become more personalized. My expectation is that that path just keeps ongoing and our ability to understand which patient’s physiology responds to drugs and all those sorts of things will keep evolving. I don’t think there’s an end state to that, but we make progress. The more interesting one is superimposed on that, the concept of personalizing an experience separate from biology, and that’s one where we are going to be able to borrow lessons learned from outside of healthcare and other services and industries which have already recognized that you need to think about your customers much more individually. As you described in your book, Gary, N = 1, markets of one. Healthcare is about the most perfect example of a market of one. The biology alone makes you a market of one, but then you superimpose whatever your individual preferences are. The probability that two people want the exact same care experience is zero, but the ability to personalize requires two arms. The first time is I need to know you in a way that is very context-specific, and that has not only understanding your illness and your preferences but there’s a time series attached to that. However, even if I do, the experience is still very monolithic unless I can figure out how to give elements of it that give you some level of control and variability, which is one of the reasons why, not just digital data, but digital platforms and software are so critical to this conversation because they allow us to convert the care experience into a blended physical and digital one. It is that blending that allows us to create a hyper-personalized experience, in addition to the personalization of the biology, which will come from the clinical data part of it, so both of those are going on at the same time.

 

Gary Bisbee  25:03

More data means more issues with ownership and privacy. If you think about privacy in terms of vaccine report cards and taking tests and tracking and so on, how do you think all of this experience for COVID will influence how we think about privacy going forward?

 

Kaveh Safavi M.D.  25:27

COVID comes on top of an already prolific privacy debate around our data that’s on social platforms and other places, so it amplifies the dialogue by demonstrating the fact that information about our physical status, for example, is ubiquitous, and that it is quite possible for people to have information about us unless we say no. Think about what happened in the very early days of contact tracing: the smartphone guys put applications in that gave phone location information. Interestingly enough, if you follow the history of contact tracing, the amount of digitization and automation is relatively limited because people did not want to passively allow that information to be available. Just because it was technically permissible didn’t mean that people were okay with it. People were very careful about the information they wanted to opt-in to, and that shows you how much respect we have to have for individuals’ ideas about their data, who has the right to it, and under what circumstances. COVID amplifies the fact that—and particularly things like your phone—there’s so much more data and everybody has it. If we don’t have conditions placed around it, people are going to use it. I’m not exactly sure how they’re going to use it, so the debate just gets more intense. It doesn’t it’s not a new debate. It’s just a more intense debate.

 

Gary Bisbee  26:51

In terms of medical care, in terms of using data for clinical purposes, how do you see the ownership issue of particularly clinical data?

 

Kaveh Safavi M.D.  27:02

From a policy perspective, I’m fairly settled in the sense that the data content is really owned by the person. Now the challenge, of course, is that the data resides in a digital expression in different people’s asset bases and oftentimes people confuse the storage of the data with the intrinsic intellectual knowledge that’s sitting in the data level. As a matter of every country, we’ve set down a basic policy rubric that’s pretty clear that data belongs to the person. The US is probably going to have to catch up to Europe in the broader concept of data protection. Privacy concepts (like the right to be forgotten) are pretty important. Where this really plays itself out in healthcare is the way we manage consent. The right to use my information has historically been at the document or the record level or physical paper level, but the fact that we are digitizing individual discrete data elements means that, if we’re really going to honor people’s intent, we have to actually manage that consent at the data element level, not at the document level or not at the visit level but really at the level of it. Every value, every code, and the idea that because all those pieces just keep finding their way into other things that file the claim file, the EMR file gets used and reused and reused. If I want to be forgotten, I have to be able to go find that element everywhere, and that’s not a record that is a specific data element, so there are a lot of advances going on right now around the technology necessary to create essentially a consent identity at every single element that’s in a record, as opposed to at the record level, but that’s only half the problem. The other half of the problem is managing that consent process. If the idea was that I was a researcher or I was a developer and I have a value proposition for you—it might be advancing scientific research or it might be building a product that makes your life better—I need to gain your consent. How am I going to do that? If I send an email to you and ask you for your consent, that’s never going to happen. We all know that, and you won’t even know how to answer that. Increasingly, there’s a whole discussion about who these intermediaries are. Some people call them “consent brokers.” These are trusted entities by the person whose data is coming. They essentially engage in a relationship with you where you continuously specify the conditions under which you want your information to be made available for others. Then people who want that information come to the consent intermediary to find out if they can get information and what kinds of information. That’s a three-party relationship. Right now, people are trying to figure out who that entity is outside the US. You’re seeing most people thinking about government or quasi-governmental agencies because they’re trusted. I think people, generally speaking, don’t trust the tech companies to take that role. At least the current level of trust doesn’t really fit better. Our research on who you trust with your data clinically puts the tech companies at the farthest away end of the spectrum. The providers are the closest end of the spectrum. That’s going to be another interesting area, even if I can technically manage it. Procedurally, how do I manage this? Both of those are becoming evolving fields and both of them are necessary to gain the real benefits of this information.

 

Gary Bisbee  30:38

We talked about providers on one end, tech companies on the other. Where do the retail companies like CVS and Walmart and Walgreens fit?

 

Kaveh Safavi M.D.  30:47

From a source of data, if they have a provider posture, then they’re following the provider path. They might also have information about you that comes from your buying behaviors, which are interesting and useful. They have their own rubric. They don’t necessarily have the same rubric, as patient data does, and that’s a matter of public policy as to whether or not we want to consider your retail information to be something that’s as protected as your clinical information. To some extent, they’re a source of data. They’re also potentially a user of the data. If they want to build products and services, just like any other user of data, they’re going to have to honor that, which is one of the reasons why—if you look at retailers who have had clinics—they have been unable, from a policy perspective, to merge retail behavior and pharmacy and the clinical pH I data together as a matter of policy. Sure, they have record systems and they contain them, but they don’t have a policy right to integrate that information without going through the right kinds of consents. They’re just like everybody else in that they have to figure out how to create a value proposition. The other thing that’s really important, and we’re seeing this increasingly going back to this issue of consent, is that people want to understand how the information is going to be used in plain English. There was a fascinating study done probably a decade ago and it was looking at patients willingness to have their information used either for marketing or for clinical trials. They discovered that, in general, people are okay if their information is used for clinical trials, whether they explicitly consent to it or not. They’re actually not okay if it’s used for marketing back to them, even if they consented to it, which goes to show you people don’t understand the blanket consents they’re signing, so it’s more of a policy perspective. The gray zone we’ve been struggling with is like with COVID, for example, you see lots of people volunteering not just their data but physically volunteering to be infected by the virus for the benefit of humanity. It is not outside of the realm of human beings that want to participate in making better medicines. What we get into is this gray area of commercial products that someone might economically benefit from that isn’t necessarily me. If a digital product manufacturer says, “Hey, give me all your data and I’m gonna make a product that helps people with diabetes or smoking or anxiety or depression,” or whatever the thing is, or makes your insurance experience better. You’d go, “Well, okay, I’m willing to have a conversation, but let me ask you something: what’s in it for me?” They’re not just turning it over to you unconditionally. They’re saying, “I’m willing to turn it over to you, but I need something in return for that.” That value exchange has to be dealt with somehow. It’s not a yes, it’s not a no, but it’s a gray zone. Recognizing it, figuring out the value, and then figuring out how to execute the value exchange is something that we’re going to make progress on in the next few years. That will help open up more opportunities, too.

 

Gary Bisbee  33:52

Well said, Kaveh. This has been a terrific interview, as expected, I might add. Let’s wrap up with one final question. You’ve alluded to it at several points during this discussion, but let me ask it directly. What do you think the single biggest issue the healthcare system is going to address in this decade is?

 

Kaveh Safavi M.D.  34:13

It’s how people’s expectations of how healthcare should be are formulated by their perceptions and experiences out of healthcare. The gap between how it is and how it should be is just getting bigger. That gap is going to get filled either by regulation or businesses that solve that problem. Those could be the incumbents—healthcare providers and payers and others—or it could be new entrants who realize that closing that expectation is a business opportunity. The widening of the expectation gap and then the narrowing of it and the filling of it is really going to be where a lot of the action is going to be for the incumbent healthcare delivery system and payers out there. This is a tremendous opportunity for tremendous risk, but it’s all fundamentally driven by people’s expectations and the fact that we’re not meeting those expectations and people aren’t standing for it. They’re going to look for some kind of a solution, some kind of a way around it.

 

Gary Bisbee  35:13

Put in simple terms, expectations of having Amazon deliver a package the same day you order it versus waiting for two or three or four or five days for a physician’s appointment. Is that an example of that expectation?

 

Kaveh Safavi M.D.  35:28

That’s a simple one. People expect everything from “I gave you my information, how is it you don’t know about me?” “Why can’t I pay this bill?” “Why is the insurance process so chaotic?” “Why is it that I have a network and insurance product network and nobody can tell me anything about who takes my insurance or who’s open when I know all this information is available?” It has that level of dimensionality to it. We have a very fragmented delivery system and people know it can be better. Some of it will be everything from “why is it that I don’t know who the good doctors are” to “why is that so hard to find out?” That’s an interesting one because that’s not just an experiential one. There’s also a clinical piece that goes into that because what it means to be a good doctor and how you communicate that is really important. What drives this is the totality of the fact that healthcare isn’t like everything else, so it would be overly simplistic to just focus on some of the basic simple complexities. Some of these things are going to be too hard for non-healthcare companies to sell for, which is why regulation is going to step in and solve it. Think about price transparency as an example. That’s a classic example of the market failing to meet people’s expectations. At the end of the day, the burden is put on the actors to solve that problem.

 

Gary Bisbee  36:47

Kaveh well said. This is a good place to land. We really appreciate your time. Thanks so much for being with us.

 

Kaveh Safavi M.D.  36:52

Thanks, Gary. I look forward to seeing you in person sometime soon.

 

Gary Bisbee  36:56

New episodes will debut every Thursday. Join me in conversations to gain advice and wisdom from CEOs, presidents, and healthcare experts. Health care leadership is hard work, but it becomes more manageable as we learn from the remarkable lives and careers of our guests. I’ll see you there.

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