Reviving Healthcare
This week I am talking to John Fryer Chief Revenue Officer Lumeris. John discusses his journey in healthcare, starting with his entry into the finance world before being influenced by innovator Neil Patterson to focus on healthcare and ended up joining and cutting his teeth at Cerner Corporation with health systems and technology, and the emergence of value-based care.
We discuss the challenge of aligning entrenched stakeholders for value-based care and the need for regulatory and policy changes. We are both fans of finding new influencers to bring about the change we know we need and view large employers as possibly bringing about disruption and change within the healthcare industry.
Lobbying and the Value-Based Care Puzzle
We dive into the persistent issue of limited adoption of value-based care despite its potential benefits, much of it attributable to the powerful stakeholders and lobbying groups, hindering the widespread adoption of the model. As part of the changes, we talk about the role of AI in addressing these issues, and while acknowledging that AI in healthcare is not a new concept it does bring some renewed potential opportunities for change, especially in improving efficiencies
Listen in to hear our discussion on burnout and disillusionment among clinicians due to administrative pressures offers hope for the future as we share a sense of optimism about the potential for positive change in healthcare, driven by passionate individuals who are committed to innovating and solving the industry’s challenges.
Listen live at 4:00 AM, 12:00 Noon, or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
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Raw Transcript
Nick van Terheyden
And today I’m delighted to be welcoming John fryer. He is the chief revenue officer for Loomis or Lou Maris, I think, as they say, in the United States, but everybody that knows me says I mispronounce all the words. So I’m just going to say I mispronounced that one as well. John, thanks for joining me.
John Fryer
It’s great to be here today, Dr. Neck.
Nick van Terheyden
So if you would tell us a little bit about your background and how you arrived at this point in your career, and you know, some of the highlights that contributed to this point in terms of the innovation and some of the things that you’re doing?
John Fryer
Yeah, absolutely. I think I’ve had a really interesting journey and landed into healthcare really, by good fortune. So intended to come out of Undergraduate Education and enter the finance world, and was fortunate to meet a great innovator in the healthcare space, and Neil Patterson, and he encouraged me to really think about the impact that I could have, and the impact of change within healthcare. And so I ended up landing at Cerner Corporation. Now, Oracle Health, spent a couple of years there and then and went back into more of the finance side of the healthcare landscape and joined a consulting firm and spent a number of years working with health systems and provider organizations across the country and really paying attention to the changes in technology, the changes in digital and the landscape. And as larger new entrants continue to seek to work with these entrenched kinds of stakeholders, I really made it my practice to figure out how these participants in the market could work with large technology companies to accelerate their adoption of, of technology. And really, that’s kind of where I found value based care. And as the payment models continued to evolve, coming out of CMS, in particular in the Medicare population, and we’ve all heard for a number of years, how the Medicare trust fund is running out of money, and we’ve got to come up with a new model to be able to create sustainable health care. And that’s really where I found my niche in in the healthcare space. In combining this transformation around technology, and digital with these value based payment models and value based care models. And the rest of this kind of history been with Lou Maris, for the last six and a half years now, it’s been a really exciting journey with our partners, and looking forward to seeing where the value based care market is going kind of moving forward.
Nick van Terheyden
So I before we jump into that, I think, you know, important to highlight what I would call a critical sort of inflection point. And you know, most people that have met Neil Patterson know what, uh, you know, influential and passionate individually was he brought a tremendous amount to healthcare, it’s a great loss to our community. And I think to the organization especially, I’m curious to know, did you arrive before or after the pizza, the famous pizza?
John Fryer
I was there during the
Nick van Terheyden
kidney, somebody that was,
John Fryer
but I was actually at the office.
Nick van Terheyden
So you had already ordered pizza? Good? Well, so those of you that don’t know, it was a very famous instance. And, you know, all due respect to Neil, he was passionate about it, I think it was, I think he even self reflected at one point, it wasn’t possibly the best handling of it, but anybody that knows him knows, you know, his contribution was enormous. And I’m delighted to hear you sort of referencing that, you know, especially as he’s, he’s left us to, to, you know, try and continue some of the work that he clearly started. So, you know, lots of interesting background in what you did. You know, I think you highlighted some of the key issues that we keep hearing, you know, we’re running out of money. I’ve been looking at this sort of percentage of what healthcare consumes of the GDP, I think it continues to fascinate me that we say, oh, you know, it’s, it can’t get any higher and it continues to get higher. I don’t know at what point that really becomes true. But it already feels like it’s true. And, you know, we are running out of money. I think anybody that’s looking at, you know, some of the future is going how is that going to survive? We look at other countries and they’re not really I don’t think there’s any model that I go wow, that really works and I’ve I’ve Seen and worked in a number of them. I think it’s, you know, it’s a real challenge. And I like you look to value based care, it seemed like it was a good model. That’s clearly what you’re doing. Tell us a little bit about the work because this is not, you know, it sounded like you just arrived here. But I think that’s not the case. You’ve been at this for a while. Tell us a little bit about what’s going on at Lumira? Sorry, it’s very hard for me to mispronounce these words, I’ll do my best.
John Fryer
No, absolutely, I think you’re really raised some some good key points. I think it’s really hard for any stakeholder in our health care kind of delivery system. set of stakeholders to argue that value based care isn’t the right model, the right theory, the right premise, better patient, better patient care more aligned around the outcome of an individual patient more focused on keeping people healthy, and trying to find a business model to enable that. And most would agree that all sounds like a great utopia, to be able to operate in an environment where all the stakeholders are aligned and achieving better one better health care for all. I think the reality is, is that the work to accomplish that requires aligning stakeholders whose interests today are not on the same page. And the entrenched business models of the past have created a system of care that currently isn’t organized to be able to execute and deliver this population health model. And so the work that’s being done today, and really where Lou Maris has committed in the marketplace, is moving as many lives as possible into value based care. And that means moving many big, large, entrenched stakeholders towards this more integrated model where the payers and the providers and the patient are engaged in actually operating in a model together to achieve these improved financial outcomes, but also improved quality outcomes. And it’s never a dull moment. There is never a day without challenge and pain. But the endpoint is getting and reaching a number of lives into that Utopia model where everyone’s aligned around, you know, high quality care for all.
Nick van Terheyden
So let’s go back to one of the points that you made. Because I, I agree with you yet. There’s so many that I must not. And that’s the only explanation that I can come up with. We look at this and we go, this is the best model. This makes sense. It aligns all of those things, it brings people together. Yet here we are. I don’t know how many years we’ve been at this value based care. That is, I know how many years we’ve been at health care, but value based care, in its current form, certainly a lot of time, and yet it remains stubbornly low, in my opinion, or at least in my understanding, on an adoption standpoint, why is that? What is going on? And how do we reverse that?
John Fryer
Yeah, I think the really biggest challenge into driving the accelerated adoption of value based care is you’ve got really entrenched stakeholders and lobbies, on both sides of the equation. And those forceful powers in the regulatory and policy world in Washington DC, have really failed to come together to collectively agree on what that model is. And so we’ve nibbling around the edges. And we found opportunities to innovate. And we found unique ways to align local markets. But there hasn’t been a big push from a regulatory and a policy perspective, I’ll be at CMS has stated that by 2030, every Medicare and largely every Medicare patient will be in a value based model of care, which is a good starting point to move the market. But it really is about alignment. And it really is about entrenched stakeholders, and it really is about money. At the end of the day in the haves and the have nots. And we’re seeing that play out very publicly in the in the press today between the dynamics of you know, the health systems and the provider community saying they’re really struggling to have a sustainable business model and you’re seeing large commercial carriers continue to report billion dollar profits with their business model, and the two sides are really at odds. And until we can drive alignment Which from Illumina standpoint, we’re focused on doing at a more local level, pick an individual market with an individual delivery system or provider network and find the right payer partners that are interested in enabling value based care. And we’ll get to work. But from a macro perspective as to how do we see broader adoption and not just certain markets moving faster than others? I think it is going to require a push from either an industry group and that could be an employer group. Or it could be the government through CMS and CMMI.
Nick van Terheyden
Yeah, I, I’ve got to say, I concur. I like to disagree with people, because it makes for a more interesting conversation. But I mean, I do I think, fundamentally agree that it’s this business lobby, that essentially refuses to shift off this, I’m gonna say, massive pile of cash, I have no other visual than, you know, Donald Duck Scrooge, or whatever, in his vault with piles of gold going no, no, I’m not giving any of this up. And I know that sounds a little bit over the top. But you know, ultimately, you sort of described a little bit of that. But you bring up a really interesting sort of potential group that has a large voting bloc, and that’s the employers, right, they have the capacity, if they could get involved. I mean, it seems like they’ve just disconnected from this and accepted this continued sort of increase. And yes, this is where we’re going. But it shouldn’t, it should never have been. But do you think that’s perhaps one of the pathways to really disrupting this space?
John Fryer
I think it potentially is the fastest way to seeing disruption. But I think we’ve continued to hear that once the employers banded together and really pushed back to say, I am no longer accepting, you know, 8% 12% increases in my premiums year over year over year. I think the challenge is it’s a it’s a rather unconsolidated lop small group employers represent, you know, a ton of the business community in the United States. And they haven’t really banded together to have a perspective. Now, some of the larger employers certainly are, and they’re becoming more loud in Washington, DC. And many have tried to take new approaches to essentially cutting out those entrenched stakeholders who aren’t willing to think differently. But the reality of what I see on the ground today is by and large, employers still don’t want to restrict the options that their employees have. So they want to have everybody that provides care in their market, in their network. And until there’s a bigger shift around kind of our expectations, as individual consumers, it becomes really hard to see, you know, what is that solution that isn’t just nibbling around the edges, whether it’s bundles, and you know, folks sending all their cardiac cases to the Cleveland Clinic, or, you know, the Mayo Clinic, or MD Anderson for cancer care, there are, you know, and there is an accelerating adoption of those types of destination models, for sure. But the broader change is really also going to require us as individual consumers, to think differently about what we want, and what is acceptable to us, because the employers at the end of the day, want to have benefits that are competitive to attract and retain the best employees.
Nick van Terheyden
So for those of you just joining, I’m Dr. Nick the incrementalist today I’m talking to John fryer, he is the Chief Revenue Officer at Lou Maris, we were just talking about the challenge of getting value based care adopted and you know, the various blocks that we’re interested, I think you highlight, you know, employers and then pushed over to employees. And, you know, if you thought employers were disorganized and couldn’t get together the idea that the employees, you know, that’s even a bigger challenge. But you’re right, I mean, that’s a huge voting bloc. But, you know, let’s talk about the other side, which is where you’re sort of focused on which is actually the delivery. And, you know, to be clear, I think one of the things that you will find universally in physician maybe not universally I’m sure there are folks that see this. Perhaps in the specialist areas where they say, you know, I should be in a different bucket, but ultimately, you went into medicine to deliver, you know, excellent care, I think Everybody, most people go in with that intent, but you get stimulated, because of the system. I think that’s truly the challenge that we face within whatever the system is. And that’s especially true at the small practices. And let’s be frank, if you’ve ever interacted with a really good small practice, you know the value of that, but they struggle, because they’ve got very little support. So tell us what you’re doing to help solve that and really deliver against that.
John Fryer
Yeah, I really liked this question, Dr. Neck. So, you know, Lou Maris was originally established by an independent group of physicians in the St. Louis market and they’d become frustrated really, with the entire scope of healthcare, just like you outline stymied by the status quo and the stakeholders that they had to deal with. They saw it as heavily bureaucratic and obtrusive to the actual practice of medicine, the actual ability to care for the patients that they served. And as Lou Maris, you know, started to flourish and mature, we really realized that we had to get back to building this transformation from the ground up. And that’s really why we launched our tribe, this capability, which I’m fortunate to serve as the president of, and it really resembled the mindset of our original independent founders, which tries to capitalize on all the learnings that they had, and we’ve had as Lou Maris over the last 10 years, for a more localized application to those independent practices so that they can get back to why they went into medicine, which was really to spend the time with their patients. And today, you hear the stories of I see 30 patients a day, I have four minutes with each I’m running between I’m eating my lunch in the hallway, between my one o’clock and my 115 appointment, and we’ve really kind of broken that model of especially primary care and internal medicine, that drives a lot of of our ability to keep people healthy, which ultimately is the goal of value based care is to keep them from needing acute delivery services.
Nick van Terheyden
Yeah, so critical in that, I think, is the fact that it was created by a group of physicians. You know, obviously, I’ll declare my bias the, at the outset, as a physician, I feel that it’s like an essential component. I think it can be clinicians in general, I think people that actually lay hands on patients deliver care. And to be clear, you know, I think this is important to understand, that’s not just clinicians, in many instances, I mean, the folks that walk into rooms and interact, and that’s, you know, even cleaning down to the levels of cleaning stuff, there’s, you know, all of these folks that really deliver care, have those folks involved. And suddenly you change the sort of whole perspective, I think this disconnect is really sort of fundamental. So you set up this concept, and, you know, you talk about this, but I gotta be honest, everybody talks about AI. What are you doing? And where’s the where’s the contribution of this? Because I’m excited about it. But I’m also a little bit suspicious when people say, because I hear everybody go AI and they go, you really? So what are you doing with AI? And what’s the contribution that?
John Fryer
Yeah, I think you couldn’t have hit it on the head better. Dr. Nick, AI is all of a sudden in every single companies, investor calls and every single startups pitch, everybody is now an artificial intelligence company. And I think the reality and why that is the case is obviously it’s a silver shiny object right now. But I do believe we are at a fundamental point of technology change early very early in that, and it is going to change a lot of what we do. But I think it’s it’s made the space very noisy when we think about, you know, artificial intelligence and our technology tools. It is not something new AI and rules based algorithms and learning models have been around for a number of years. And what we’re seeing with the accelerated adoption of these large language model language models, and the technology acceleration that has allowed some of this science and data to occur, is it’s really interesting to look at how that might change our healthcare world. How we’re thinking about the the impact of AI today is really not much change from you know, 234 or five years ago. It’s about how do we reduce the administrative burden that is placed on all in the healthcare ecosystem? And so when I think about these physicians that we just talked about, and how they only have four minutes with their patients, the reason why they only have four minutes with their patients Ken says we’ve forced upon them through regulatory and policies and, you know, technology, adoption to figure out how to use things that were designed, not focused on patient care. And we’ve really got to use AI and how Lou Maris is thinking about it and try this is thinking about it is how do we reduce the burden on the care team down from the front office staff all the way through the visit, but really focused on the back office at this point, and the process and the clicks and the workflow and the documentation and coding that has to occur. Because what we believe a failed model for a future system is, is just asking our care teams to do more with less resources. And it seems like everything we do is just like, well just do this now a little bit differently fill this other form out now. And that’s what’s created this model that I really view as unsustainable. I really view it as unfulfilling for future physicians, I don’t you know, envy folks looking to go to medical school now and they talk to their, their, you know, mentors that are out in the field, like the administrative headache of health care today is, is a burden.
Nick van Terheyden
Yeah, I’m afraid I’m going to concur again. You know, the sad fact is, and it’s not a scientific study, but I interact with a fair number of my physician colleagues, and any that have children, I have not heard a single one who has said to me, I am encouraging my children to go into the career. And I actually have a daughter who has followed my career almost directly, and I will tell you, she’s bitterly bitterly regretting that decision, because of all of the things that you described. So we have a true crisis on our hands, I am just appalled at where we are, that she’s feeling the same kind of, you know, awful pressures of a system. So, as we sort of close this out, tell us what you’re doing what you’re hopeful for in the future. And where you see all of this going?
John Fryer
Yeah, I think it’s right now, it’s very easy to accept the doom and gloom that’s painted out there in in broader kind of media and the messaging and the broader kind of culture. But I think what I’m excited by most is that there still are very passionate people looking to innovate, looking to drive change. And that may be folks that are looking to drive macro impact, but it’s also folks that are looking to drive local impact in their community in their practice. And every day, I feel like, I’m fortunate that even after listening to 10 minutes about what isn’t working in a clinic, it always ends with the optimism of what it could be and what it can be, and how we can get there and how we could think differently. And, and, you know, despite kind of a pessimism, and I think we do have to solve this, you know, bringing people back into medicine, for the reasons that folks originally went into it, that’s a big problem we’ve got to solve to for for all of us. But I think what gets me most excited is there’s still people that wake up every day saying we’ve got problems, and I’m not going to bury my head in the sand, I’m going to contribute to a solution. And I’m willing to continue to fight. But it is becoming harder for many, and we’ve got to continue to enable those voices to be heard, and put them in places to drive impact. And I think that’s what makes me excited for the future is that there are still a lot of people waking up every day willing to try and tackle these existential problems.
Nick van Terheyden
So I, you know, I concur with this sort of, you know, doom and gloom, I’ve I’ve been hurt to say that my glass is always full, it’s, it’s, in my case, it’s always half full of whiskey and half full of air, but, you know, everybody else can have the water. That’s fine. I’m with you. 100%. I think we can find the positive in this and it is especially challenging, I think my, my major concern is that we lose or I’ll have the potential to lose many, you know, bright opportunities of, you know, both individuals and also ideas in the you know, the challenges that we face going ahead, but I agree with you, I think it always comes back, you know, you just have to hear that one story and, you know, even I on my personal journey of you know, I focus on those positive instances where you You know, institutions that truly brought me to the lowest point in my interactions with healthcare system still had individuals that I interacted with that I could not talk about in a more positive fashion. And it’s those individuals that we have to support with all of the things that we do, unfortunately, as we do each and every week, we’ve run out of time, so it just remains for me to thank you for joining us on the show. John, thanks for joining me.
John Fryer
Thank you, Dr. Nick
