[Podcast] Patient-Centric Care: Does the Doctor Know Best?
If you’ve been listening or reading along with us, then you know we’ve covered a number of discussions in preparation for a panel discussion about patient-centric care at the 2019 Eye for Pharma conference.
Lynn Nye, CEO of Medical Minds, moderated and co-sponsored the panel with me. Held in Philadelphia on April 17, 2019, the recording and synopsis are below.
Naturally, we began the panel discussion with introductions. I’ll give you the cliffnotes version here so we can get right into the meat of the podcast.
First, we have Mia Nease who headed up commercial at Arivale. Next is Fasiha Haq, who’s responsible for Global Medical Education at Eli Lilly and Company. It’s her job to bring the patient voice into everything they do. Third, we have Sven Gierlinger, the Chief Experience Officer at Northwell Health, the largest healthcare company and employer in New York. It’s his responsibility to ensure Northwell Health is the most patient-centric organization they can be.
And as most of you know, I’m Stewart Gandolf, CEO of Healthcare Success and a new agency we’ve recently founded, Aria Agency, which is more focused on the pharmaceutical business.
Let’s dive into the discussion:
Defining the communication gap between physician and patient
The first topic of discussion centered on how patients want to receive information from their physicians. “While many doctors feel they are distilling information in a way their patients understand, only 75 percent of patients agree,” states Ms. Haq, “Physicians tend to focus on long-term outcomes and the disease aspects of care, whereas patients are more focused on the day-to-day, short-term quality of life issues.”
Mr. Gierlinger went on to say, “We talk about the interruption—that the patient gets interrupted [within 11 seconds]—but if you let them talk, they only speak twice as long.” This has the added benefit of making sure the patient feels heard. Over the last five years, the transformation I’ve seen is fantastic, there has been a paradigm shift from a self-centric ‘I don’t care if they like me, I just want them to get better’ viewpoint to a patient-centric position. The pendulum is finally swinging the other direction and it’s very exciting to see how it’s shaping not only healthcare but pharma as well.
Mia Nease wrapped up this part of the discussion with three thoughts, “The gaps our members are telling us about are in primary care. We attribute that to the limited time a physician can spend proactively working on preventative health. Secondly, many treatment recommendations are not taking into account the holistic picture of the individual (e.g., genetics, gut health, history, diet, exercise, sleep). Lastly, our healthcare system is too focused on disease rather than keeping people healthy. However, we’re slowly seeing the shift from reactive sick care into a proactive preventative personalized participatory approach to health and I'm so excited that the biopharmaceutical community is leaning into that.”
The panel agreed that one of the big disconnects is a perceived lack of time for office visits. However, studies continue to show that taking a moment to pause, ask questions and listen to the patient upfront can help build rapport, better understand the patient’s needs, improve patient outcomes, bridge the communication gap–and save time.
A look at successful initiatives
Ms. Haq developed an innovative and award-winning program that was so successful in rheumatology that other disease categories within Eli Lilly are interested in using it.
“The program, Conversations in Motion, is designed to teach healthcare professionals effective communication techniques,” says Ms. Haq. “Given their time constraints, we had to carefully consider the criteria and requirements. The goal of the program is to bridge some of that disconnect or discordance that exists between physicians and patients. The program focuses on communication techniques like shared decision-making, building empathy and trust, practice efficiency, and adherence. It has a very simple framework. It explains the technique, why it's important, and how do I apply it simply and succinctly.”
“What we're hearing so far is very good in terms of how it is improving not only satisfaction but long term outcomes for patients and physicians—because it's saving them time.”
Accelerating widespread adoption of patient-centric care
Each month at Northwell Health, doctors come together for a lunch and learn type session called Communities and Learning Practice. As we all know doctors are extremely busy, so understandably they may not be eager to take on additional time-consuming initiatives—despite how vital it is for patient experience and patient outcomes. “I think the number one influencer there is the leadership buy-in or leadership commitment to a program like that,” says Mr. Gierlinger, “and that's across the organization. The other point is to get the physicians involved in designing it. Another reason I believe [this program] successful is because it answers the doctor’s question ‘What's in it for me?’ It connects them to why they went into medicine in the first place.”
Mr. Gierlinger talks about one doctor’s a-ha moment after attending the session, “She said to [her patient], ‘What else?’ She never asked that question before. And, he broke down crying before sharing his wife has cancer. She never would've learned about that if she hadn’t asked the question. She asked why he didn't mention that before and his answer was, ‘You didn't ask.’ That's very powerful. Every single physician has one of those moments and that's why they believe in it,” Mr. Gierlinger concluded.
Mia Nease added her thoughts on what can be done to make patient-centric care mainstream, “First, we need to have better collaborative models between healthcare systems and new technology-based approaches. The second needed change concerns health economics associated with preventative care. I know of a particularly large and ongoing study that’s testing to see whether investing in personalized participatory proactive care can reduce healthcare claims. They're two years into it and the results are looking good. I think between collaboration, partnerships and a change in economics we should see a gradual uptick towards the mainstream.”
The team at Healthcare Success is filled with digital communications experts, so Ms. Nye asked me how to scale programs to effectively to manage this shift toward patient centricity. Digital marketing can gather actionable data—that used to take years to get through traditional marketing—in a matter of days.
Again, this is just a synopsis of our EyeforPharma panel, “Does the Doctor Know Best?” This is a very comprehensive panel discussion with industry leaders focused on patient experience and patient-centered care and I highly recommend listening to the entire podcast or reading the full transcript below.
I'm Lynn Nye from Medical Minds. We're a medical communications company and we specialize in physician and patient education. That's why we're really interested in this really important topic of patient-centric care. Today we have a really wonderful panel of speakers with a wealth of information. Actually, Stewart and I talked with them all prior to this event, and I have to tell you, they all talk a lot and have a lot of things to say.
Stewart Gandolf:
We're not shy.
Lynn Nye:
Actually, what we did was we recorded the conversations and we've made them into podcasts, and so once they approve them, they'll be available. If anybody wants to get more information from them, you just have to bring your business card to me and we'll email you some links to the presentations.
Lynn Nye:
Anyway, to start off, they could introduce themselves much better than me, so I'm going to ask each panel member to introduce themselves and tell us the great work that they do. Let's do it in order, then. Mia, seeing as you're the first picture here, let's hear from you first.
Mia Nease:
Yeah. Thank you so much, Lynn, and thank you so much for having me here. It's a pleasure and an honor to present to you today. My name is Mia Nease. I head up commercial for Arivale. That basically translates into looking after healthcare/life sciences partnerships.
Mia Nease:
Arivale is a company that spun out of Dr. Lee Hood's institute, and those of you who have got a genetics background will no doubt recognize Dr. Lee Hood's name. His contribution to science and to medicine across a 60-year career has been absolutely outstanding.
Mia Nease:
Our company is focused on optimizing wellness and avoiding disease, as well as producing some really great science from the de-identified data that we generate. Why should you care about this? Well, if you're on the commercial side or the med affairs side, Arivale is really an interesting platform to conduct real-world evidence and late-stage trials. If you're on the patient side, you'll see that Arivale produces some really, really outstanding clinical results. I'm looking forward to talking more about kind of the patient centricity and what we're doing for our patients.
Lynn Nye:
Thank you. And Fasiha?
Fasiha Haq:
Hello, everyone. Thank you, Lynn, for inviting me to this panel, a great pleasure to work with you all. My name is Fasiha Haq and I'm responsible for Global Medical Education at Eli Lilly. My role is, really, as I see it, is to bring the patient voice into everything that we do. It's always keeping us real internally in pharma, not drinking too much of our own Kool-Aid, and ensuring that all of the outcomes that we are gearing all of our medical affairs activities towards are really focused on what matters at the end of the day, which is improving patient outcomes.
Lynn Nye:
Okay. Thank you, Fasiha. And now, Sven, let's hear from you.
Sven Gierlinger:
Good morning, a pleasure to be here. I'm Sven Gierlinger. I'm the Chief Experience Officer at Northwell Health. Northwell Health was previously known as North Shore-Long Island Jewish Health System, and we're now the largest provider of medical services of integrated delivery network in the state of New York. We operate with our affiliates, 23 hospitals, but we've grown tremendously also on the ambulatory side with 700 physician practices, and then all the other elements that are part of the continuum of care. In my role, I basically am responsible to make sure that we are the most patient-centric, the most customer service-focused organization that we can be, and to work with all the different entities, and to make sure that we achieve that.
Lynn Nye:
Thank you. And Stewart?
Stewart Gandolf:
Hi, I'm Stewart Gandolf, and I also am likewise very pleased to be here. Thank you for inviting me. What's exciting to me about having talked to everybody on the panel before, the diversity of viewpoints we're bringing to this discussion today.
Stewart Gandolf:
I'm CEO of a company called Healthcare Success, as well as a new agency we just formed, or founded, a couple days ago, Aria Agency, which is the pharmaceutical side. I feel like I have a double life. We're straddling both worlds of pharma and provider.
Stewart Gandolf:
What's exciting to me is that the ... We do a lot of speaking and a lot of writing within our agency work, and we talk about there's really six ways to build a provider, for example, where it's doctor referral building, digital PR, branding, external advertising, and mostly, patient experience. People forget that patient experience is really a vital part of everything. It's really kind of one of my passions that we get to see every day that we get to impact, so I'm very honored to be here because it's something I'm passionate about, so thank you.
Lynn Nye:
Yeah. So you see we have a diversity of opinion and multiple perspectives, which is really important for this discussion because patient-centric care is also a very multifactorial situation. So anyway, this is a really exciting time for us, as we all know, as we transition. We've been hearing about it yesterday, and I'm sure we will again today, from the sick care system to a personalized wellness and preventative care healthcare system.
Lynn Nye:
In speaking with the panel prior to our event here, it's very interesting because they were all in sync with this idea of acceleration. That's the word that came up in our conversations. How can we accelerate this change? What we're going to do today is we're going to try to answer that question, first of all by defining the gap between physician and patient communication. And then we are going to talk about some successful initiatives, and there are a lot of successful initiatives in this panel here, actually, that you're going to hear a little bit about.
Lynn Nye:
And then we're going to talk about ways in which we can engage multiple players to develop real world scalable strategies that will really begin to accelerate the change. I'm going to stop talking now and ask the first question, and the first question is for Fasiha. In your research, Fasiha, what have you learned about how patients want to receive information from their physicians?
Fasiha Haq:
Thanks, Lynn, sure. After a typical consultation, if you were to ask physicians and patients what was communicated and actually what was understood, you would find a discordance in their responses. As you can see on this slide, a physician may feel that they've actually asked a patient or discussed with them the approaches to achieve their goals, but in fact, only approximately 75% of patients would actually agree with that.
Fasiha Haq:
Often, the top concerns from a patient perspective are actually at the bottom of a physician's list of concerns. That's because physicians tend to focus on long-term outcomes and the disease aspects of care. Patients, on the other hand, are dealing with holistic aspects, more than just one life domain. They're focused on more of the day-to-day short-term quality of life issues.
Fasiha Haq:
I don't know if you've heard this study, it's called Soliciting the Patient's Agenda. It's a little bit old, but it's been replicated and the numbers ring quite true. What the study actually reports is that patients are interrupted after a mean time of 18 seconds when asked to describe their concerns, and only in 1 in 52 visits can the patient actually return to their original concern. What's even more alarming is that as of 2018, so just last year, in two studies conducted in the US and Canada, that mean time has dropped to 11 seconds.
Fasiha Haq:
The crux of the discordance actually stems from a perceived lack of time and also having conversations with every patient in the very same way. There's many areas I find in which physicians and patients both don't formally set mutual expectations. They're not even aware of the misalignment in their understanding most of the time.
Fasiha Haq:
One of these areas, quite simply, is the volume and depth of information that a patient prefers and how active they want to be in decision making. If physicians were to ask a simple questions of patients around this topic, physicians typically say one of three things. They'll say, "You're the expert, Doctor. Just tell me what to do," or, "Tell me ..." Sorry, or, "Please make a recommendation and give me the reasons why," or, "I want to know everything, and let's make the decision together."
Fasiha Haq:
Often by asking questions upfront, you can not only build rapport, build trust and empathy, but you can address the patient's ... or you can understand better the patient's motivations, concerns. That actually does show that it aligns up very well with improving both adherence and outcomes in the long term, and it saves time.
Lynn Nye:
Yes, thank you, Fasiha. That's very insightful and very important work. So Sven, next. Sven at Northwell Health has developed an amazing system, a comprehensive training initiative. So tell us how that has impacted the way that physicians speak to their patients. I have a slide here, I think, on ... yes.
Sven Gierlinger:
Yes, so I've been there five years and about a year after I started, I asked the question, "How can we create a more standard of care for physicians with patients in terms of communication and that focuses on the experience of a patient?"
Sven Gierlinger:
We developed a program that we call our Relationship-Centered Communication program. Our physicians have created a partnership with an organization called the Academy for Communication in Healthcare, and we're partnered also with a medical school to infuse what we're teaching our medical students there, which I didn't mention earlier that we have, and to create a curriculum that is based on a three-function approach. That breaks down that encounter, whether it's a 5-minute encounter or a 20-minute encounter into three areas, and that includes what we call the empathy microskills to make sure that we actually communicate with empathy with the patients.
Sven Gierlinger:
We talk a lot about patient-centered care. We used to talk about that it was provider-centric. The pendulum was provider-centric, then it swung over to patient-centric, and we believe that it's somewhere in the middle that it is relationship-centered, that it's collaboration that we work together.
Sven Gierlinger:
And so far, we've ... The number there says 919 doctors. Actually, next week on Friday, we're going to have a thousand doctors that have gone through it. They spend an entire day with role play and with really learning new skills. Sometimes it's physicians that have been practicing for 20 years, 30 years, and they feel like they have great communication skills. They go into it a little reluctantly at first, but then they walk out, and we have many, many testimonials where some of these long-term physicians have said, "It's amazing. I feel now that I've been practicing medicine for 20 years, and I've practiced it the wrong way. Now I feel like I have better relationships with the doctors and with the patients."
Lynn Nye:
That's great. So Fasiha has to send all her rheumatology patients to Northwell Health, right?
Sven Gierlinger:
We talk about the interruption, for example, that the patient gets interrupted right away, but if you let them talk, then it's only twice as long, actually, and other strategies that that doctor can employ to make sure the patient feels heard.
Lynn Nye:
Yeah, it's great. Oh, and actually we have one more slide here. Just quickly, that shows how success-
Sven Gierlinger:
Yeah, that's just the impact of how our communication with doctors have improved over the years. That's the H-CAP's domain, and it's really been remarkable. The other impact that it's having is that physicians are leaders, obviously, and it sets the tone for the organization. It makes the nurses focus on that more. It makes everybody else focus on that more because what I've seen in the past is the question is always, what about the physicians, you know? You make us do that, but what about the physicians? And this is ... It's a great story.
Lynn Nye:
Thank you. So, we come to Stewart. So Stewart talks to physicians in private practice and institutions every day. So tell us, Stewart, what do they tell you?
Stewart Gandolf:
Yeah. It's really funny, and to build on what Sven just mentioned as well, how the doctors are at the center of this universe in the provider level, the hospital level. I think it's so compelling that you have respected doctors from within your organization leading these educational classes, because that way it has inherent credibility. Without the credibility of the doctors, it just ... if you come in to some consultant who's not clinical, they'll sort of half-believe you.
Stewart Gandolf:
What I've seen is a couple of, I don't know, five years ago, I had the honor to be invited to speak at Cleveland Clinic's Patient Experience Summit. Over the last five years, what I have seen, the transformation is fantastic. There I met Dr. Jim Merlino, who's a mutual friend of Sven's and mine. Jim is kind of at the forefront of this whole world. He's now with Press Ganey. He used to be the chief patient experience officer there, he's now with Press Ganey, and he's even impacting some pharmaceutical now.
Stewart Gandolf:
But I think it's really fun, as I've gotten to know Jim ... And now we're more than colleagues, I think we're real good friends at this stage. But we talk about how at the beginning of this journey, doctors would ... and I'm talking five, six years ago, even ... "I don't care if I make them happy. I just want them to get better." That's kind of a very self-centric viewpoint.
Stewart Gandolf:
I remember a patient experience right about that same time, my mother fell and broke her hip, classic story, of course. They lined her up at the hospital on a gurney so it was convenient for the radiology department. So she's sitting out in the cold because it was convenient. It was not patient-centric, it was operational-centric.
Stewart Gandolf:
This has been a true revolution on the provider side over the last five years. It's very, very exciting what we're seeing, and all of a sudden, this is a topic. And now here, we're at a pharma conference, where I told you about my double life where patient-centricity is here. I'm pleasantly excited to see how much of the agenda this meeting is talking about these issues, how focused people ... It's not lip service. It's for real.
Stewart Gandolf:
However, I got to say that there are still objections out there. I talked to somebody last week who shocked me. Essentially, she's a doctor and her position was, "Well, patients aren't qualified to make any decisions and just leave it up to the experts." This isn't what we're talking about at all today.
Stewart Gandolf:
So there are still remnants out there. Remember the whole innovator, early adopter curve, late majority, and laggards. I would call her in the laggards. But I feel that's really exciting and some of the things we talked about on our various conference calls is, how can work together to cross these boundaries between pharma, between private practice, between hospitals, and work together? Because at the end of the day, if it's truly patient-centric, then we have to consider from all of these different angles.
Lynn Nye:
That's right, Stewart. Absolutely right. Actually, that's always the case, isn't it, when you have different perspectives and you collaborate together that the outcome is so much better than you can do from one person at a time.
Lynn Nye:
Okay, so Mia has a very exciting company that she works with a very exciting background. In your work at Arivale, Mia, what have you learned about the physician-patient communication? I know you work with lots of different specialties, so does it vary by specialty?
Mia Nease:
Yeah, for sure. A lot of people that come into the Arivale program are quote, unquote, healthy, right? So they come in as healthy participants who are either the worried well or the health optimizers or health hopefuls. In some cases, they're also people who are struggling with chronic disease and are not getting quite the support they need from the medical community.
Mia Nease:
The average age of our ... and we don't call them patients on our side. We would call them members or participants because we make the assumption that these are healthy individuals who want to optimize their wellness and avoid disease. So the gaps that our members are telling us about are in primary care. Many of them have moved several times over the course of their lifetime. They tend to find primary care for their kids, but then as adults, they're lapsing on having a PCP, so they're relying on other sources, telemedicine, et cetera, to address those sort of primary care needs.
Mia Nease:
Participation in wellness programs or executive health programs is low when you look at company-sponsored initiatives. Any HR professional will tell you that even the really high-end executive physicals, the participation rate is only about 35% across the population. That's even the ones that don't have a copay.
Mia Nease:
We're seeing low participation and we attribute that to a couple of things. One is the amount of time that a PCP can spend proactively, working on preventative health with a participant is very limited. It's about 20 minutes a year, and that's just broadly. Secondly, a lot of the recommendations that are being made are not taking into account the holistic picture of the individual, so that includes their genetics, their gut health, their past history, their diet, their exercise, their sleep. And so, individuals that are participating in our program really love the fact that we can tailor our intervention based on a very rich, dense dynamic dataset. They like that.
Mia Nease:
And then, I think thirdly, as a society and as healthcare system, we have essentially perverse incentives when it comes to reimbursement, and that's because much of it is about billable codes. It's about disease as opposed to keeping people healthy. There's not a lot of money in preventative health, right? If you look at wellness as a venture capital category, it's been very tattered.
Mia Nease:
We're slowly, slowly starting to see the shift from reactive sick care into a sort of more proactive preventative personalized participatory approach to health. I'm so excited that the biopharmaceutical community is leaning into that. In particular, that I know of, Novartis and J&J, their CEOs, their C-suite are very open about funding initiatives around preventative health.
Mia Nease:
Yesterday, I was attending the presentation by Janssen's executive around The World Without Disease, which is all about disease interception. I think as a healthcare community we need to be traveling further up the food chain and really helping intercept disease before it manifests in suffering.
Lynn Nye:
Yes, I quite agree. And I have to admit, I don't have a PCP and I'm thinking about getting into a program like the one that Mia just described to us. Okay, so we're going to talk now about two ... There are lots of initiatives out there, and we're going to talk about two very successful initiatives now.
Lynn Nye:
First of all, Fasiha developed an amazing program. It's an award-winning program. She might not tell you this, but she got an innovation award from Lilly. Not only that, this program was so successful in rheumatology that all of the other disease categories within Lilly are thinking of copying it. It also got an award from Medical, Marketing and Media this year. It's a fantastic program that was developed at Lilly and it's one that Fasiha spearheaded, so tell us about it, Fasiha, and tell us what the goals were and why it was so successful.
Fasiha Haq:
Sure, sure. The program Conversations in Motion was developed with rheumatologists, so it was in the rheumatology field, but I would argue that it actually applies pretty much across any therapeutic area. It's basically a program that is designed to teach healthcare professionals effective communication techniques. Given the time constraints that they have, we had to be very careful in what the criteria we set out to develop this program was.
Fasiha Haq:
The goal, really, of the program is to bridge some of that disconnect I talked about earlier, the discordance that exists between physicians and patients. I think the main reasons, Lynn, why it's been quite successful is it addresses a true gap. We identified a need through a very thorough needs assessment, consultations with hundreds of rheumatologists across the globe. They really shared that there is, in fact, still a lack of training and education in communication. How do you build empathy and trust? How do you do all of that within 4 minutes or 10 minutes or 12 minutes?
Fasiha Haq:
One of the things they shared is, it would be wonderful to have such a program, but in order for it to be successful, here's what you're going to need to do. The ground rules they set were high, or stringent, I should say, but they were good to have at the outset. And because we were able to meet some of those, I believe that's why the program has been successful.
Fasiha Haq:
So what did they tell us? They said in order for a program that focuses on communication techniques to be successful, you need to make sure that all of these techniques are grounded in science. They are based on scientific evidence. Okay, they need to be applicable to my world, to my clinical practice.
Fasiha Haq:
They need to be easy to apply, meaning not only that it's practical in that I can apply it myself, but I can teach it as a rheumatologist to other rheumatologists because to your point, the credibility only comes in when it's a peer-to-peer program. I have to tell you, this program is non-promotional completely. It does not talk about any drugs whatsoever. It's simply focused on communication.
Fasiha Haq:
Another of the ground rules, of course, was that it did need to improve patient-physician satisfaction because as you know from studies, that has been shown to improve outcomes overall. And most importantly, it needed to not take more time than what they have in their allotted visit. In fact, if possible, please develop a program that actually helps us save time.
Fasiha Haq:
So we had our marching orders, and in order to do this, we actually collaborated not only with the rheumatologists but patient advocacy. We collaborated with communication science experts, psychologists, and sociolinguists to make sure that the framework was such that it met all of these criteria.
Fasiha Haq:
At the end of the day, the program basically focuses on communication techniques that address the topics you see in this slide, shared decision making, building empathy and trust, practice efficiency, and adherence. It really has a very simple framework. It explains the technique, why it's important, and how do I apply it? That's basically it. It doesn't bog you down in the theory. While the theory is important, if it's based on the science, they felt that gave them the minimum that they need to know, and let's move on with how do I do it in daily practice?
Fasiha Haq:
The format of the program, originally, the version 1.0, I'll call it, was a series of PowerPoint modules, very interactive, meant to be in small group discussion-based forums. The second iteration is now interactive videos because it has become now mandatory in many hospitals and clinics for all of the staff. And to make that practical, it's not always practical to do everything face-to-face, so we've created the videos. Those have been wildly successful. In fact, in two European hospitals, they have made it mandatory for all Fellows to complete all of the videos in training prior to writing their exams.
Fasiha Haq:
Many of the countries across the globe are now partnering with advocacy societies to come up with a complementary program specifically for patients. The results so far are they are starting to also measure impact, so I think I'll have more data in a year's time. But what we're hearing is very good in terms of how it is improving not only satisfaction but long term outcomes for patients and physicians as well, because it's saving them time. I think overall they're finding that that's leading to much better discussions, and they're making the most of the time that they have.
Lynn Nye:
Yes, and now you know why she got an award for this program. Okay, Stewart, so what aspects of your work at Healthcare Success contribute most to improved care, would you say?
Stewart Gandolf:
What's fun about ... I got into marketing, actually, on a lark. I thought I was going to be an engineer. I love science and math, but I took a marketing class and I just loved, and I still to this day love influencing human behavior. I don't know what it is. It's just something that's fun to me.
Stewart Gandolf:
Our entire company was built around generating action and getting patients to take action and getting doctors to take action. And so, a couple of just anecdotes that Lynn and I have been discussing recently. One is we just launched a new program for a biopharma in San Diego, which there our task is we have to find patients that have stage III or stage IV inoperable solid tumors, they have to be with this criteria and this criteria in Southern California for orthotopic testing on mice.
Stewart Gandolf:
Essentially, if you don't know about this, they kind of ... Most genetic testing with mice, they actually take the tumor out of a human being and put it into a mouse subdermally. With orthotopic, they actually take it ... If you have liver cancer, they put it into the liver.
Stewart Gandolf:
This is a complicated concept, and the idea here ... The benefit of that is not for science, it's for the patient because if they take that same tumor, put it into five mice, they can tell which chemotherapy responds ... well, which drug. It could be other forms of drugs besides chemotherapy. But at any rate, whatever the mice responds to, whichever one responds best is much likelier to work better in the human. You can imagine that's not only ... If you're short on time anyway, to narrow it down quickly to the most effective drug, not to mention the unnecessary human suffering on a drug that isn't less likely to work is pretty amazing, right?
Lynn Nye:
Yes.
Stewart Gandolf:
That's an exciting thing. So what's fun about my job is already within days of launching, we have people calling, real, live actual patients that are calling this little needle in a haystack, so that to me is very fulfilling.
Stewart Gandolf:
And then another anecdote of the clients have ... Maybe the reason why that's relevant to this is, I was talking to Lynn about the creative approach. We designed that program so that the website starts with the most basic, advanced testing allows your doctor to ... work with your doctor to get the best possible drug treatment, or most likely to be successful drug treatment. And then it breaks it down layer-by-layer because some people want to know everything, some people just want to know the opening, so that's particularly fulfilling.
Stewart Gandolf:
And then just another anecdote about our world, we worked with a completely different, much easier situation. A primary care provider asked us, they were so excited when we met them to get a new patient a day. And now, we get them 20 patients a day. So by raising their new patient count, they've grown, obviously, helps them scale. We were talking about earlier, it's not just they're more successful economically, but because they can scale, they can provide better care.
Stewart Gandolf:
One day driving around he was telling me, "Look, Stewart, you guys helped us make a more healthy community." We're able to reach patients in terms they can understand. I would argue this is where when we talk about patient experience, to me there's two rings, right? There's patient experience and there's marketing, but there's an intersect where they really work together well, and that's why it's a passion for me.
Lynn Nye:
Yeah, that's terrific. Actually, and the website that Stewart's talking about is really, really great. It does exactly what he said. So to your point, Fasiha, that some patients just want to know the bottom line, and some people want to know the detail. It's set up so fantastically, so congrats, Stewart. That's really good.
Stewart Gandolf:
Thank you.
Lynn Nye:
Okay. All right, so we're going to move on to accelerating widespread adoption of patient-centric care. The first question I'm going to ask to Sven. You saw that the program that they've developed at Northwell Health is highly successful. So my questions to Sven is, what are the reasons for the success and what are the obstacles in our healthcare system that prevent other organizations from doing exactly the same thing because we know that they don't?
Sven Gierlinger:
Yeah, so starting with the reasons for the success, and I don't want to raise the flag yet that we have succeeded. I think we are on a journey and everybody's on a different part of the journey. Even when you're successful, there's still ways to improve that.
Sven Gierlinger:
But I think the number one influencer there is the leadership buy-in or leadership commitment to a program like that, and that's across the organization. I think that starts with our CEO who I have the fortune to report to. He makes patient experience very important at the system level, that trickles down to the physician leaders, to our chief medical officer who hand-selected the faculty, the 36 physicians that actually are running the program. Many of them are physician leaders that are really busy medical directors of hospitals or service line chairs, actually.
Sven Gierlinger:
For example, the physician lead for the whole program, Dr. Kalman, she is now the executive director, the CEO of Lenox Hill Hospital in Manhattan. She still practices medicine, she's a cardiologist, and she still teaches this course once every six weeks or so, which is a tremendous commitment, which is also often the barrier. It took me two years to get it off the ground and to get the organizational buy-in, but that was a good thing because that way we were able to socialize it and we were able to make it right, too.
Sven Gierlinger:
The other point is to get the physicians involved in designing it. That's something I learned a long time ago because I don't come from healthcare, I come from the hospitality industry. The previous CEO of my previous organization, Henry Ford Health System in Michigan, gave me that advice early on. She said when you work with physicians, there are three things you have to keep in mind. One is you have to respect them for everything they have accomplished and the work they do. Two is you have to work with them and collaborate with them, and that's what we've done here. And three is you have to love them, you have to give them a hug every once in a while. That's something I keep in mind all the time.
Sven Gierlinger:
Another reason why I believe it's successful is because it goes to the "what's in it for me" for the doctors. What's in it for them is it connects them to why they went into medicine in the first place. There's many anecdotes and Dr. Kalman, who I just mentioned, has one where she has a patient that she's seen for years and feels like she has a very good relationship with him.
Sven Gierlinger:
One day, because of what she'd learned in the class, in teaching the class, she said to him, "What else?" She never asked that question before, and he broke down crying, and he was talking about that his wife has cancer. She never would've gotten to that if she didn't ask that question. That added time to her schedule that day, but it was very, very meaningful. She said to him, "Why didn't you tell me that before?" And the answer was, "Because you didn't ask."
Sven Gierlinger:
That's very powerful, and every single physician has one of those moments and one of those aha moments, and that's why they believe in it. And now they come together on a monthly basis, like a lunch and learn type of situation. It's called the Communities and Learning Practice. And then they talk about patients and they talk about how they apply the tools. It makes them feel more connected to their mission to the work they do.
Lynn Nye:
Mm-hmm (affirmative). So I can see Amon here. Are you saying there's a question?
Amon:
I'm just wanting to check with you whether you're comfortable taking questions from the floor.
Lynn Nye:
Yes, we are. Okay. We do have a couple of other things-
Lynn Nye:
... hearing from Mia and from Stewart that we want to tell everybody.
Stewart Gandolf:
I can give you the short version.
Lynn Nye:
All right. So let's have the short version from them, and then let's take some questions.
Stewart Gandolf:
But there will be some, thank you.
Lynn Nye:
We have a final question that actually is really interesting, too. I want to ask Mia. The work that Mia is doing is really leading edge, doing genetic testing and coaching. It's at the leading edge of personalized care. We discussed that the human touch here is really important, so what do we need to do to make this mainstream? I'm going to ask you to speak quickly because we're ... of course, I knew this would happen because I always talk a lot.
Stewart Gandolf:
Not me.
Mia Nease:
Okay, so in order to make this mainstream. I think a program like Arivale's that is very high touch, provides a lot of data, but has relationship-based accountability built in with a human coach where the participant or patient can communicate with their coach via a secure app or over the phone as much as they want. I think it's really important for behavior change.
Mia Nease:
Clearly, that's not possible to do in a PCP or a hospital setting, right? And so, I think in order to make things mainstream, we need to have better collaborative models where the health system and new technology-based approaches work together as part of a continuum, including on things like behavior change, which is so critical to managing lifestyle-related diseases, which is frankly affecting a very large percentage of our population.
Mia Nease:
The second thing that is needed is to change the health economics associated with preventative care. I know of a particularly large study that's being conducted by Providence St. Joseph's. They've got a thousand of their caregivers in a preventative health program and they're tracking over a three-year period to see whether investing in personalized participatory proactive care can indeed reduce healthcare claims. They're just two years into that study and the results are looking really, really good. I think between those two things, collaboration and partnerships, a change in economics, we should see a gradual uptick towards mainstream.
Lynn Nye:
Good, so I was going to ask Stewart, but he won't mind if I don't ask him, probably.
Lynn Nye:
I was going to ask him because his team are expert at digital communications, so how could we scale programs effectively, but-
Stewart Gandolf:
I can give you, like, 30 seconds, real quick.
Lynn Nye:
Okay.
Stewart Gandolf:
Well, it's just interesting because that's kind of the Holy Grail is how do we use technology to scale, and that's been a topic in some of the other breakout sessions I've heard. For example, Mia today was talking about ... And it's very difficult, right? It's more complicated than just an app. But Mia was talking about, as we sat down this morning, about a new app that's for behavioral care, that's for cognitive behavioral therapy that actually has been very effective, right? So that's exciting.
Stewart Gandolf:
From my standpoint, just the digital marketing part in my 10 seconds left is, I love the fact that we can test, track, and adjust. So when we're doing marketing with digital, stuff that used to take years to get, if you're trying to do traditional marketing, you run a TV ad and did it work or not, that's six months, a year, in days you can make changes. It's just a really exciting time on the marketing side, on the technology side. Sometimes it has to be great big funding, sometimes it can be a very guerilla and at least get the direction very quickly. How was that?
Lynn Nye:
Okay, good. Okay, so we have a question, you said that.
Amon:
We do. I think this has been a very focused and yet comprehensive panel discussion, and also exceptionally well-prepared, so my compliments to all of you for putting in the effort to get there. But I'm sure that the conversation has prompted questions from members of the floor, and I have got one to start with, and this is aimed for Sven.
Amon:
The program that you described as reaching a thousand participants, and they're all physicians or healthcare practitioners.
Sven Gierlinger:
Correct.
Amon:
Yeah. But the conversation around which this is based is two-way: it's a patient-healthcare professional conversation. To what extent were patients themselves involved in the design or even the delivery of the program that you've got?
Sven Gierlinger:
We have patient partnership councils, 18 across the health system. They were not actually sitting at the table, but as we rolled it out, or before we rolled it out, we were able to get their input into that as well. But we do a lot of work with our patient community.
Amon:
And the second question that I've got from me before we come to the questions from the floor is it feels as though there are a lot of well-intentioned but relatively small initiatives aimed at improving the interaction between healthcare professionals and patients. Is it time that we, as an industry, stood up and actually tried to do something-
Lynn Nye:
Yes, yes.
Amon:
... across the industry to broaden the reach of the programs that we're doing, with this, we're touching tiny minorities of physicians and patients with this.
Lynn Nye:
Actually, that was our last question. I was going to give them all a minute to tell us.
Lynn Nye:
Do you want to go to that?
Amon:
Yeah.
Lynn Nye:
Could you ...
Amon:
Let's go to that.
Lynn Nye:
Okay. So, actually, when we were talking with Fasiha, she said the one thing that always keeps recurring to her mind is, how can we break down the barriers between companies and institution, and collaborate for the overall benefit of our patients? I have to tell you that if anybody in the audience would like to work with us, we would be absolutely delighted to spearhead a program like that, that would involve multiple pharma companies.
Lynn Nye:
I've worked with ... Sorry, I'm talking a lot. But I've worked with companies, for example, with the National Coalition for Cancer Survivorship that was sponsored by every single company that provided oncology products. It is definitely possible for pharma to come together and also for advocacy groups to come together and do these wonderful programs. So if you would like to ...
Lynn Nye:
So anyway, what I asked the panel to do is to give us an idea of one of ... They have a minute each to give us one or two ideas on how to break down these barriers and achieve this. So, Sven ...
Sven Gierlinger:
Well, I think that this panel is a great example of that, that there's a lot of commonality from different sectors that we're trying to effect here, and I think opening those channels of communication and working together. I believe in storytelling and that's something we do as an organization, also, and the stories that back up the data and that brings us back to the mission of why we do this. If we focus on that, then we can break down the barriers.
Lynn Nye:
Quite right, yeah. Okay, Mia?
Mia Nease:
I keep going back to the fact that some of the greatest unmet medical need in our community is related to people, particularly women of color. It's a very understudied population, yet suffering from a tremendous amount of chronic disease.
Mia Nease:
What I would love to see is a biopharmaceutical initiative combined with some of the new technology approaches, like the ones that we're doing, to come together and really make an investment in serving patients that are not being taken care of today. The Arivale program is great, we have tremendous clinical outcomes, but the reality is 90% of our participants are of European ancestry. And so, we are not able to then really do some deep phenotyping and genotyping and really study chronic disease in diverse populations because of that.
Mia Nease:
And so, we would love to come together and study a chronic disease like obesity or diabetes or cardiovascular disease together with a biopharmaceutical company, but very much focused on underserved, understudied populations.
Lynn Nye:
Yeah, I just want to say one thing. Actually, I was talking with someone from BMS a little while ago and he gave me a hard time because he said every ad board should include people from underserved areas because they have such a different perspective on healthcare. Okay, Stewart.
Stewart Gandolf:
I think this is a start, actually, doing cross-collaboration with different perspectives. I think that's really important. I feel like, perhaps, hospitals may have a couple years headstart, although they're still brand new at this as well, so I think it's a really new idea.
Stewart Gandolf:
I think that also leveraging technology again is so powerful. I'll give an example, not an app, but if anybody hasn't seen the Cleveland Clinic's patient empathy video, it's amazing. I play it during my seminars, we do seminars, and people get to tears just watching, looking from the patient's point of view.
Stewart Gandolf:
The point is that's a video. It's been downloaded many millions of times, hopefully it's going to be downloaded a hundred more times after this meeting, but it's fantastic. So if we think through ... And then Fasiha I think has a great point, too, when we were talking, I'll let her speak for herself, of no one company can bear this burden. Somebody yesterday from Johnson & Johnson said the same thing. "We want to help, but we can't bear this burden alone."
Stewart Gandolf:
But if we think it through strategically and figure out, okay, we can reach millions of healthcare providers, and this is not just other hospitals, these are people, physical therapists in Edmonton or some place are watching these. I just think it's very powerful if we plan it well and work together. Fasiha?
Lynn Nye:
Okay, Fasiha? Yes.
Fasiha Haq:
So, short version. Well, you know, it's interesting, right? Patients, one thing that stands out to me is a patient, and we have the privilege in pharma of listening to patients all the time through focus groups and whatnot. I remember in rheumatology this patient said to us, she had gotten diagnosed after something like eight years, actually. She said, "Everywhere I went, I just felt like nobody really listened to me." And she said, "Finally I decided to stand up for myself, and the next physician I saw, I said, 'You know what? I am not a joint, so look at me as the whole patient.'"
Fasiha Haq:
And William Osler, who has been a pioneer in the field of medicine, and I'm sure you all know this quote, said, "The good doctor treats the disease, but the great physician treats the patient who has the disease." I think to get there, we need to focus on that common goal. Break down some of the barriers or assumptions that we have, break together multi-stakeholders together because, you see, there's a lot going on, right? And just here, while it's energizing, I kind of get the sense like, "Oh, my goodness, there's so much going on. I have no idea about all the things that are going on."
Fasiha Haq:
Isn't it better maybe to put our heads together and see where we can collaborate, how we can break down some of these barriers and focus on what is the common goal? We may not have the answers, but I'm very confident given the smart people on this panel and others that we have within these different stakeholder groups, we can actually get there if we work on it together.
Lynn Nye:
Yeah, so I'm really serious. We would love anyone here who wants to collaborate with us. This is my email address. Please email me or come and give me your business card, and we'll be in touch. And we're also happy to share the podcasts. Amon?
Amon:
Lynn, in the interest of time-
Lynn Nye:
Yes, I know.
Amon:
... I'd like to have just one question from the floor, and I'd like to give that question to a member of the patient panel. If the question could be asked and addressed by just one member of your panel, please.
Lynn Nye:
Please.
Michael M.:
Hi, my name's Michael Mittelman. Appreciate the talk. I missed part of it, but I did want to know since you're all from different industries, a lot of what's talked about is listening to the patient, treating the patient holistically, patient-family advisory councils, things of these sorts.
Michael M.:
If you're really living in sort of one area, rheumatology, if you're living in recruitment of patients, if you're living in maybe the hospital system, Northwell being more integrated, how do you value the success of a partnership with patients? How do you expect to collaborate with patients and family members when all everybody really wants is free time from us?
Michael M.:
I guess that would be my biggest question and challenge to all of you, you can think about it, but one of you, if you could answer it. Collaborating, right? Let's talk about ways to collaborate. You all have jobs to be here. We don't, so I guess how can we collaborate where we value people holistically? That's a question.
Lynn Nye:
Actually, I just want to say that I would, personally, I hope you have some time just to talk with me because I'd like to hear your answer to that question, too, truthfully, because that's something that we kind of grapple with in our industry. Anyone want to pick up that question?
Sven Gierlinger:
Everybody's looking at me.
Stewart Gandolf:
You're the closest to it.
Sven Gierlinger:
It's troublesome that there are these perceptions. I think that our goal as an organization is also, and it talks a lot about what's been discussed also, and what you discussed, Mia, is like the ... Look at holistically, look at not just as a patient holistically, but look at the community holistically, and look at the social determinants of health, and making sure that we serve everybody within that.
Sven Gierlinger:
And that for example, through behavioral health, through that nobody wants to invest in, through food insecurities, all these things that affect the health of individuals. And then how can we serve more people, and how can we maximize that impact in terms of health outcomes, and to grow healthier and healthier communities is really what we're focused on in partnering with our patients on that.
