How Can We Achieve Health Equity for Rural Populations?

[00:00:00] Jared: Hello everyone. And welcome to another enlightening episode of the MedDesign podcast, where we delve into the minds and stories of those leading the charge in healthcare innovation today, we're honored to have Dr. Lisa Schock with us and named synonymous with strategic healthcare leadership, population health, and transformative healthcare solutions.

Lisa's expertise spans various facets of healthcare, from value based care strategies to global product technology. Lisa's journey from her early days as a PA to her current leadership roles reflects her unwavering commitment to enhancing patient care, fostering clinician alignment, and championing evidence based practices.

Her work is a blend of passion, innovation, and a deep understanding of the intricacies of the healthcare landscape. In today's episode, we'll dive deep into her insights, her approach to population health, and her vision for the future of healthcare. So without further ado, let's dive into it. Welcome Dr. Shock.

[00:00:50] Lisa: Thank you so much. Appreciate you having me.

[00:00:52] Jared: Yeah, we're happy to have you with us. And so just getting started with population health generally, can you explain to us what it really means and why it's become such a focal point in modern health care today?

[00:01:03] Lisa: Sure. So I'm a Duke PA and a doctorate of global public health and got my doctorate in public health a bit later in my career.

And as a clinician first, we always think about people and the person standing in front of us, right? So that person really is a blend of physical health, mental health, and what we call social drivers of care, right? So you might hear people say your zip code is more important than your genetic code. So that's where we get into More population based health, right?

Talking about those zip codes, thinking about those regions, those areas. Are you urban? Are you rural? Are you in an area that might be a food desert? All of those factors really influence health. And as a rural primary care provider and also do some urgent care and nursing homework, as the clinician first, I tend to think about populations as well as the individual people.

[00:02:00] Jared: Absolutely. And when you're talking about these diverse populations, something that can come up is just the challenge of trying to coordinate care amongst these diverse populations. And maybe you can also talk to about some of the challenges you've experienced there.

[00:02:13] Lisa: Absolutely. So I'm a big fan of the interdisciplinary team.

And I will often say it takes a village to raise a patient, a lot of the work that I've done. At the state level, I've served on the Institute of Medicine and done different things across North Carolina as my home state, advocating for a team based approaches to care and as a former practice owner in a really underserved area.

We didn't have a dietician and a social worker, and sometimes even the psychiatrist might only come once a week, right? And we also didn't have specialty care. We were a primary care office, but maybe cardiology is only there on Tuesday, or neurology doesn't come at all, or GI is only there on Friday, right?

So thinking about what do patients need, what are their chronic conditions demanding in terms of that interdisciplinary care? to really address those health concerns. Diabetes is a perfect example, right? Diabetes care involves a lot of different disciplines. If you're really going to go broad and think about nutrition and drugs with pharmacists and are they overweight or not?

And we can get into a whole separate discussion about obesity management and then hypertension and some of the primary care stuff. And then, oh, by the way, Complicate that with a social driver, like maybe they don't have good transportation to get to their appointments. Maybe they're in an area of the community that doesn't have broadband and they can't really do a telehealth visit.

So, I tend to think about population health and patient care in that broader sense.

[00:03:53] Jared: That's a fascinating one because when you think of rural patients, you think, Oh, okay. This is a place where digital health, telehealth solutions start to really take place. But then now what happens if they don't even have access to broadband?

Like how you said, that was something I wanted to ask also is just. How the pandemic happened and it made telehealth quite a bit more popular because necessity and and um, still I guess there's a subsegment of the population still to where that doesn't really help them necessarily. So

[00:04:22] Lisa: I think the pandemic magnified kind of the cracks in the foundation.

We in North Carolina, most of our counties are rural. We have a couple of larger cities, Charlotte, Raleigh, Asheville's growing like crazy, Greensboro, but all of those other counties in between. Are really quite rural and especially in the eastern part of the state. And we don't yet have great broadband coverage in all 100 counties, so we're working on it as a state and lots of different agencies from the Medical Society to other professional organizations are really pushing through work that they do through their foundations or other things to really improve that connectivity.

But. Especially in the pandemic, it wasn't just about broadband. It was about the device, too. So, I worked for a global digital healthcare company that was all virtual and did visits, just like we're talking today. If you had a phone that was somewhat smart, but not completely smart, meaning that it couldn't hold the app because maybe the app was too big for it.

Then there's another barrier. So you think you can get healthcare to everybody who has a phone in their pocket. That's only kind of partially true.

[00:05:32] Jared: Yeah. Something also about that strikes me about population health is the amount of data that you're aggregating to start to make these like really important decisions.

You know, with the emergence of artificial intelligence, has it made it easier to find trends within this data and make decisions based on that data? Or is this something that I guess you're not integrating just yet in your practice?

[00:05:54] Lisa: So I would say yes and no to that. So I used to work with a really beloved colleague who is a chief medical informatics officer.

He's a physician leader, and he used to say there's no shortage of data. It's the applicable data and the accurate data that we need. So when I was working in big ACOs across the country, And thinking about helping those physicians and practices and clinicians come over to more value based care from fee for service data was an incredibly important part of that conversation.

In order to tell a physician, you have 5000. diabetic patients, for example. Are you meeting those quality metrics to take proper care of that patient population? Are you getting the hemoglobin A1Cs? Are they getting their eye exams? Is their blood pressure under control? Do they have protein in their urine?

Are they keeping their follow up visits? Are they compliant with their meds? That's a lot of information. And then physicians and practices and hospital systems, everybody has an issue with what we call attribution of patients. You could see me once in urgent care and see somebody else three times in primary care.

And depending on the dates and the rolling months, that patient could mistakenly be attributed to me. When they're really fours, right? So the first hurdle that we usually hear is that's not my patient. Right? I've never seen that person before. This list is attributing them to me. You're holding me accountable for their A1C of 12.

And I swear I haven't seen them, you know? Oh, dear. That's one issue. The other issue is accuracy and integrity of the data, right? So we have to have an ability, whether it's an insurance company, whether it's a physician group, whether it's a population health organization, we have to know what we're pulling and how we're pulling it and what the parameters are around that data in order to make it what we call actionable, right?

So if you come to me and you say, Lisa, you have 2, 500 diabetics in your panel, right? Like that you've been attributed. These patients and you're responsible for my first question is, are they mine? My next question is, what are you measuring me against? And what are my targets? There are national quality targets around HEDIS metrics and ACO metrics that we expect our partners to meet, right?

So, if the target is that, and I'm making this up, 80 percent of the population needs a hemoglobin A1c, then I need a report that says what am I doing, what is my group doing, if I'm part of a group or a system, and what is the national benchmark, so I need to know what that timeline is. How am I tracking towards that?

So, it gets pretty tricky, right? To figure out what's attributed to me, what's attributed to my group, how do I compare? And then once you have that bridge to build between where you are and where you need to go, what are the action steps? And what are the plans that you need to make in order to get there?

[00:08:56] Ty: I had a question going back to your earlier comment about just trying to care for rural populations. Mm hmm. They're talking about data. It seems like there's an incomplete data problem where you just have people that aren't showing up on the radar in terms of being able to have access to care. I'm sure that's also a major challenge when you're trying to deal with rural populations or trying to care for rural populations.

[00:09:17] Lisa: Definitely. And especially, so we will often say things like lines of business, right? So you have Medicare, which are 65 and up. You have Medicaid. which can be 64 all the way down to newborn, but that's obviously state driven and income driven, right? And then you have what we would call commercial insurance, right?

Through a job or a company or a spouse or partner or whatever, especially in Medicaid, we have about a 50 percent unable to reach rate. In that population, because that particular population has more social drivers, right? So generally, they're not high income, right? That's a qualification, they frequently live in a rural community, they might have a government issued phone or even a plan issued phone or community based phone.

But guess what? Those phones, just like your printer, you have to buy cartridges, you get minutes in an allotment bank, right? that get renewed. So depending on if my office is trying to call you and it's the first of the month, I might get you. But if it's the 20th of the month, you might be out of minutes by then.

So you're going to go off the grid for a little while. Yeah. So you're going to go off the grid for a little while until your bank of minutes renews and then I can reach you again. So that gets back to our earlier touch point around the interdisciplinary team. In my opinion, The best care comes when you do a lot of different approaches and you meet people where they are.

I've had teams that literally will go and drive, somebody's living out of their car, and they'll go meet them in the parking lot, right? Or under the bridge. And that's just what we have to do to reach that person. But other people may have that phone, may have that bank of minutes, and we figure out how to get in touch with that person and or get them in.

And then a third way is to couple that need for like primary care or chronic condition care with a community agency or community organization that we know they'll be at, like a Dollar General or a Walmart or a pharmacy.

[00:11:24] Jared: Yeah, Kelly Ayala brought up a good point as well. She says that forcing patients to be on hold is inequitable because they're paying for minutes.

Exactly. I my mind. You're burning them up. Oh my gosh. Totally agree. Something you also brought up was value based care and something I also really want to talk about today. And really what is value based care, but then how do they differ from accountable care organizations? Because I think those are two separate things, but then similar under the population health umbrella.

[00:11:50] Lisa: Yeah, great question. So I describe value based care as proving that we're fabulous. So we as clinicians, we're always like, we're great. We take great care of our patients. We do a wonderful job. And a lot of times we really do, but value based care makes you prove it. Because we have to prove it through the data.

We prove it through our quality metrics. So getting back to those 2, 500 patients that I was mentioning, if you gave me in a panel of my greater population, if 2, 500 of them were diabetic, and I was meeting those quality metrics for blood pressure and hemoglobin A1c and eye exams and all that stuff, then it's an indirect measure of what I'm actually doing.

For my patients in terms of delivery of care, accountable care organizations are a flavor or crayon in the box of value based care. So organizations that are accountable care organizations can be a health system. It can be a health system and an independent physician association. It can be a physician group.

It's any group of providers that raises their hand and says to CMS for a Medicare contract or a payer. For a commercial based contract or Medicaid for a managed Medicaid contract. I can do this care. My providers can give great care and we are willing to risk it, meaning that if we meet those quality metrics, we deserve a bonus in the accountable care world in Medicare, for example, because I spent a lot of years there.

There's a C. O. Metrics that the federal government CMS lists as part of that contract. And those are the lists and the dashboards that end up getting created for each participating provider in the accountable care organization to deliver against. So if you have a hundred docs in the ACO and one of those diabetes metrics is one of the ones that you're on the hook for, you've got to meet the target.

For that metric in order to unlock the dollars. And when I say unlock the dollars, there are lots of flavors of value based contracts. There are every almost if you've seen one, you've seen one, there are lots of types through our government and states. But in general, a shared savings contract means if you meet the targets, you will share in the savings that you would have allegedly Contributed for that population so CMS or the government will take your population and they'll estimate how much is going to cost to take care of these people.

And then if you meet or beat that you'll have a delta or a difference between how well you and what was expected to be done in those are the dollars that you'll share. And those percentages depending on the amount of risk that the organization or hospital system takes. It can be variable. Sometimes it's more risky, meaning you're going after more of the dollars.

Sometimes it's 50 50. There's a lot of nuances to value based contracting.

[00:14:53] Jared: Something I wanted to talk to you about as well was like, who's taking on the financial risk in these different models? When I first thought about it, I was thinking that in the value based care type model and accountable care models that essentially the physicians are taking on more risk by having to create these outcomes, and if they're not facilitating these outcomes, then they're not really necessarily getting compensated the same way, but the way you've described it makes it seem like It's actually way better for them to participate in this sort of model because there's incentive for them to hit these achievements more so than that they won't get paid at all.

[00:15:26] Lisa: So it depends. You have to follow the dollars. Is that physician an independent practice? Or are they employed? And is a part of their employment contract contingent on their performance on their quality metrics? And some organizations have a withhold, like, let's take 5 percent and put it over here and you can earn it back.

And this is, again, Jared, you've seen one contract, you've seen one contract, right? Because everybody does it different. But there are a lot of health systems that are employing physicians and the newer graduates from medical school. Independent practice is not necessarily en vogue right now, right? A lot of people are taking those first jobs at a fellowship with a hospital or health system so that they don't have to worry about some of that overhead and some of those other risks that owning an independent practice has.

But on the flip side of that, you're at the mercy because the contract sits at the health system. So if the contract sits at the health system, then where are you in the chain to collect some of those dollars, even though you're doing the work to meet the metric? Does that make sense?

[00:16:40] Jared: Yeah. The other part that I thought about was with this model, you're relying on the patient as well, to some degree where it's like, If they are not taking care of themselves, they're not being consistent on your panel, right?

And then, so then how does that happen? Where does a patient get disqualified from this sort of care because they're not? Participating or not keeping up.

[00:17:05] Lisa: That's a great question. So we in ACO leadership, where I've spent some time, we try really hard not to allow the groups. The clinicians to cherry pick, right?

Because, of course, you want a population of people who are all coming to their appointments and all keeping their aren't no showing and all taking their medicines and doing their tests, right? Everybody wants that. But everybody has a certain proportion of. Patients who, for whatever reason, it could be financial, it could be a social driver, I'm acutely aware that not every prescription I write gets filled, right, for a variety of reasons.

Even though it's my recommendation, it's not always taken. So there are actually specific rules that kind of define attribution, just like we were talking about earlier, is that my patient or not? So sometimes a physician or a clinician or a practice group may get attributed a handful of patients that they say they've never seen, but in a risk based, value based contract, then the onus is on that practice to call that patient and say, come on in, we need to have a visit.

We want to take care of you. And so that the work to get that patient in the door falls a little bit more squarely on the practice.

[00:18:23] Ty: And you're touching on a question from Dr. Brian Spencer here, which is what is your concern with value based care contracts and their result in a risk stratification during provider patient selection or pay your panels.

That's what we've been talking about.

[00:18:38] Lisa: But yeah, yes. And the other thing, and I would say we're not quite here yet, risk adjustment is a really important concept, right? And being a rural primary care provider for my years, I am acutely aware that a rural practice or a federally qualified health center is probably going to have a greater proportion of diabetics who are uncontrolled, for example, because there's nowhere else to go!

Right. They might be the main practice in town and they're open for business. So that's who those patients are going to come to, as opposed to a bigger city where you might have eight or 10 practices who can share the love and share the patients, right? Because you're not going to get all of them, but especially in a rural community.

You might disproportionately, as a federally qualified health center, get a greater proportion of patients who are legitimately sicker, right? So, doing that risk adjustment, and this is where I would say, in my travels, our data has not always been exactly there to fully risk adjust across populations, across practices, across regions, because that's a harder thing.

[00:19:53] Jared: So something I also am curious of is at the end of the day, this is all for the betterment of the patient and for patient outcomes. During your experience, have you seen actually improved patient outcomes through these value based models and accountable care models and just what's that looked like throughout your career?

[00:20:10] Lisa: Definitely, and I would also say it's not just the patients if you're in a good system that's doing it well. I think CMS just published their top 50 accountable care agencies. and their shared savings a couple weeks ago, and there's tens of millions of dollars there, right? So those providers are getting those bonus payments, and you could argue that they're being paid appropriately for the good work they're doing for their population, right?

To me, that's a value based care.

[00:20:38] Jared: Absolutely. So we've done a lot of talking about value based care, and there's a lot more to you than that as well. And part of your career, you've also spent being an educator. And from your experience in education, how do you see the connection between academia and the real world practice and does your experience in real world practice impact the way you teach the material to your students?

[00:20:59] Lisa: I would say definitely. I love making it real with my students and getting out of the ivory tower, right? I think if you're not Practicing, and that's part of the reason why I've continued to have uninterrupted clinical practice for my entire career. I may be hanging on by a part time thread, right? I'm not full time doing it, but I am still doing it.

So when I'm in the C suite or I'm talking with another leader in a health system, I get it. The EMR is painful. Like, all those things hurt when you're behind and you're busy and you're trying to care for the people that are in front of you. But I think it's really important for students to also hear that kind of real world experience because we can get academic on any topic at all.

But I also think it's important for them to understand that balance and those pressures of the real world. Another thing I really enjoy doing in the courses that I teach is I bring an expert. Experts, people who are doing really innovative or creative things, and let the students hear from them firsthand as it relates to our curriculum, because I think that's really important.

I just finished up a class and we were talking about health equity and wellness, and one big inequity in North Carolina is maternal child health disparities, and I brought in an expert on working with the maternal child population and a person who ran teams. That work with our health departments and work in those communities so that the students can appreciate that depth, if that makes sense.

[00:22:35] Jared: Absolutely. I hate to bring up AI again, but this was like a big news item that came up a lot was Chachapiti came out and all the students are using it and they're cheating on their tests or whatever. And was this something that you all experienced during your time as an educator and did you program?

[00:22:51] Lisa: I did update my syllabus this fall.

Oh really? To inform the student, we have discussion boards, we have papers, we have lots of ways that we teach. Right. And I think chat GPT and AI are definitely have their place in the world, but I don't want a student using it to write their paper. Right? So, as an educator, we have to be really clear about that.

And we have to say, we expect you on the honor system to say that you're not going to be writing your papers or your discussion board posts or creating a majority of your deliverables using AI because that's not your research. That's not why you're in this program, right? Like you're supposed to be bettering yourself to go after this degree.

[00:23:34] Jared: Yeah. Like you're supposed to become the expert, right? And versus just asking the chat bot. Exactly. And in your career, that's going to be a really hard thing to do when you're at patient level and you're like, Oh, let me just type in my handy dandy thing over here. Just I'll get the answer for you. Just one sec.

And then also with education comes the mentoring side of things and. How has mentorship really influenced your career? Have you had any good mentors during your time and the role of mentors are for the healthcare profession in general?

[00:24:03] Lisa: Absolutely. Yes. I've been very fortunate. I've had fantastic mentors and still have mentors, right?

Like even later in your career. I think your mentor demands might change, right? Like you might have differences in maybe what you're asking for, the advice that you need, or the guidance that you would benefit from. But I also think it's important to pay it forward. So I have students that I'm now an advisor for a capstone project, or somebody else was my thesis advisor in the past, right?

Or Even just being available as I have a lot of people who contact me, I want to go to PA school or I want to leave clinical practice and do stuff like you. And I'm like, let's have a conversation because that's years in the making. Right. I'm happy to share my lessons learned so that. People don't bump around if they don't have to, but some of it really is, as we say in the country, time and tincture.

You just have to keep having those conversations, exploring opportunities. You might hit 50 dead ends, but then one, one road will open.

[00:25:06] Ty: So you brought up teaching creativity, innovation within schools of medicine and like early in healthcare education. I'm curious where you've seen some of the cool ideas and certainly building empathy like you just shared with maternal infant outcomes with at risk populations.

So I'm curious like where you've seen some of the breakthroughs and kind of healthcare education.

[00:25:24] Lisa: Yeah, I definitely think one, and this is really not that new, but medical education has benefited from standardized patients and Robotics and bionic kind of experiences to learn anatomy or to accentuate some of that learning.

And some of those simulated patient labs are really developing even more than when I was a student. I was very fortunate to have that in my early education, but fast forward a bunch of time, the newest simulated patient models are incredible. And I think that's a real testament and statement to How we can leverage and use technology to accentuate that learning.

[00:26:06] Jared: Yeah.

[00:26:06] Ty: And also just like with our podcast guest last week, Dr. John Buzanilek, where he was using his simulation lab to then test new care models, quickly bring innovation practices back out to the health system. So I think the link between the simulation and like being able to make sure that can you actually serve this population?

I just think it's like very much a frontier in healthcare innovation.

[00:26:29] Jared: Yeah, another side of your expertise also, because you definitely have a hard path to follow for a lot of folks, because you just are so good at so many things. And another side of your world is healthcare consulting. And what inspired you to venture into this independent healthcare consulting landscape?

And what are the unique challenges and opportunities that you've faced during that time?

[00:26:48] Lisa: Yeah. Thanks, Jared. I am a unicorn. So honestly, my first foray into health care consulting was when I owned a rural primary care practice. Because I tell people all the time, it's an amazing journey. You'll learn a lot, but it's not the best financial move, right?

And during those times, I wasn't taking my full salary to pay staff. Because we needed to keep our doors open and we had rent and supplies and other bills to pay. So at that time, I thought to myself, maybe I can just make a little extra on the side with a side hustle to leverage some of this experience.

And interestingly, that was before a lot of my value based work. So that was more, back then, it was more like consulting around being a PA, how to use a PA in a practice, because we're still a pretty young profession as PAs. Right. We're not that old compared to nursing and others. Right. But as my career has continued, now I can obviously do consulting on value based care and ACO because it's been my lived experience for the last 15, 20 years.

[00:27:57] Jared: Yeah. And you're, you're describing the life of a business owner. I was thinking about it too, when you were talking about like why physicians don't go into independent practice right away too, is. Because at the end of the day, like you went to medical school, you didn't go to business school necessarily.

And so then you get into it, into just the real world hits you like a ton of bricks, the stuff that you didn't get to learn. And yeah, it makes more sense to ease into something like independent practice. Once you've already established yourself like that. And so some of the other stuff that I noticed that you consult on as well as like home health strategy and global product technology, and yeah.

Have you developed some of your insights around that and how do you stay up to date and ahead of the curve and in some of those fields?

[00:28:37] Lisa: Yeah, you might have heard me mention earlier geriatrics is my clinical love. And I spent a lot of years in the nursing home because it's honestly one of my favorite places.

So the home health, hospice, DME, assisted living, skilled nursing, all of those things are pretty close to my heart because The other piece of that is that as a society in the United States, we don't do a good job in the long term care financing. And when I was a student at Gillings, I actually spent a whole semester like writing an alternative payment model for long term care because The sad truth is that in the United States, you either get Medicaid or you spend it down.

Like, long term care insurance, if you have dementia and you're one of those that goes a few years, you're going to outlive that insurance, right? So it's super challenging to think about the financing of all that.

[00:29:34] Jared: It's a world that I've lived as well. Had a grandparent with dementia that lived the world you're talking about there.

And my dad had his own recent health issues where this Sort of stuff came up and it was just, I want to almost ask you, how do we fix it? But it's just the systemic,

[00:29:51] Lisa: I have ideas. I just haven't gotten them passed.

[00:29:56] Jared: Yeah. Yeah. It's been something where I just wish that there was more funding built into the system towards it. Because when you go to these skilled nursing facilities and they have patient ratios that are insane, stuff that you wouldn't even, in a hospital, you wouldn't even sniff that in a hospital.

It's what, 10 to one in a sniff facility or something. And these people that are working there are just flying around. But at the same time, in skilled nursing, they still have a high level of care that they need. A lot of these folks.

[00:30:24] Lisa: And they have a high level of acuity to your point.

[00:30:27] Jared: Yeah, absolutely. And so I guess just at a high level, where can we have.

Some softball wins initially to where maybe later on some systemic wins can happen where across the board we have better care for our older generation.

[00:30:40] Lisa: So one area that I. I haven't seen as much as I would like to see, but I'm hoping to see more is using technology in a good way. Right? So I'm only half kidding when I tell my husband, whose godmother has stage 4 cancer that I want to put a furbo in her house.

So the furbo is a little camera with the dog treat. Right? And she doesn't have a dog, but it'll let me see her and she can talk to it. Right, or using iPads in the nursing home to to facilitate video visits, because during the pandemic, it was heartbreaking when when families couldn't visit. And I had some of mine who were faces against the glass just waiting for their loved ones to come outside.

So I think there's a lot. That technology can benefit for care of our older adults, but it gets back to follow the dollars, right? Who's going to pay for that? How does it get resourced? One of my proposals back in school was essentially a tax that would suck away a little bit from everyone in order to have a pot of money to do good things for the people who need it later in life.

Right. When I was a state employee way, way back, they sucked 6 percent away in the beginning and it went into the state retirement fund. So similar idea, because if you voluntarily ask people to do that, when you're 20, 25, 30, you're like, I'm invincible. I'm healthy. I'm never going to get old. Why should I pay for that?

So unless it's forced, and that's my opinion, you need dollars in order to make some of these changes happen. And the other thing is. It's also pretty fascinating to look around the world globally and how elders are treated and how family structures are and what home based care looks like. I think hospital at home is one of those newer models of care that is heading in the right direction.

People want to age in place. They don't want to die in the hospital most of the time. And people want to be in their house, they want to be with their cat, or their dog, or their loved ones, and they want to be in an environment that's safe and comfortable to them. So I do think we're getting there, but I think as a country, as a nation, and as an economy, we are very not there.

So I think there are a lot of moving parts.

[00:32:53] Jared: Yeah, another part that I thought was like, what about like the lotto and taking some of the money that comes out of the lotto? And this is

[00:33:00] Lisa: Instead of funding education, fund long term care. Golly, I know it. I have a long lotto list, by the way. I literally have a lotto list.

I haven't won yet, though.

[00:33:10] Jared: The numbers are looking good these days, though. It's time to take a shot on it.

[00:33:13] Lisa: I know. When it gets to the billion, I'm like, that's enough. I can make that work.

[00:33:18] Jared: It's so crazy. I was like, also just thinking about as a 30 year old, thinking like, What's going to happen when I'm 75, I'm being around all of this now.

And I'm like, I really hope that they make a robot that can just help cook my meals and I can just talk to it and do something for me because people say it's inhuman, but I'm like, at the same time, I could be home and maybe less. Yeah. Anyways, now we're just going down a whole nother rabbit hole here.

Okay. So we did get some interesting stuff in the Q and a. So let's see from Brian Spencer again, as a firm believer in technology, innovation and playing devil's advocate, should educational institutions encourage the use of chat GPT and the next tech around the corner? Oh, interesting. Could it possibly elevate the level of learning, improve discussion boards?

And as the AI ML advanced, will it advance the educational experience? We expect students to use the internet search. Use a computer to produce documents. Those modalities were technologies that took time for adoption. If we set the goals and expectations for utilizing the technology, we can reap the benefits.

Maybe that's an interesting perspective.

[00:34:27] Lisa: I agree largely with a lot of what was just said. I think the challenge as a university professor is how do we govern it? So as a part time adjunct faculty, like how do I really know? Right. Like I'm grading papers now, you know, like, how do I really know if chat GPT was used other than an honor system?

I don't think we should stifle the curiosity or the learning that comes from exploring those new technologies. I do think that's how we advance. I think the challenge comes in. How do we as future educators appropriately use that technology as part of the learning and not have it take over the other core competencies like critical thinking that are really important for those learners to have?

[00:35:12] Ty: It's almost like you don't want to penalize students for exploring new technology and like trying to find new applications. For it at the same time, if you're using it to take shortcuts that limit your learning, that's a misapplication of the technology because it's abdicating your critical reasoning skills.

Exactly. So we had another question that came in from Martin. So he's an audiologist and a result of rehabilitation is correlate to the time you spend with the client. It's important to understand client needs. And for that to happen, you need time to connect with your client and home audiology is perfect to create trust.

How do you see the future of value based care in terms of audiology? I guess that's a pretty specific question.

[00:35:56] Lisa: Yeah. Yeah. It's a great question. And as a geriatrician inside, we need more of you, right? Because hearing loss facilitates advancement of dementia, right? So losing one of those critical senses is incredibly important.

And so this is where I even get my own profession, right? I can't be the only PA in a company of 5000 people and be advocating for my profession to get a slice of shared savings when the Contracts are written physician only, right? And I can't control if the physician shares with the other clinicians in their practice, right?

So I think that's this audiology example is a really good example of how we need to broaden the seats at the table and. If you're not at the table, you're on the menu. So would want to have any profession really cut out of the opportunity to participate in value based care. And that's where I would look to what is the professional state federal organization for audiologists?

How are they partnering? With the bigger skilled nursing facilities that might be entering into ACOs or bigger health systems that you know are in ACOs, right? Because that transition of care from hospital to home is not always hospital to home. It can be hospital to a nursing home. So there's a piece of that transitional care.

That I think the elephant is big enough for everybody to have a bite, but how legislatively and how from an advocacy standpoint in terms of policies are other professions playing a role in that? And I would say, Martin, for audiologists, your pathway probably lives somewhere in that transitional care pathway, whether that's a hospital at home pathway, or An actual facility pathway, because I would imagine that if you had a great relationship with the health system and they would think of you as a preferred provider for audiology services, if a patient was hard of hearing, you'd be pretty high on the list to.

Be able to meet that member and participate in that care and contribute meaningfully, and then you should get a slice on the back end.

[00:38:12] Jared: Thank you for that. We're getting 10 minutes left. I still want to cover another piece of who you are, which is a leader in healthcare and something that I've been curious to ask as well as just your philosophy on leadership.

What makes a great leader in healthcare?

[00:38:24] Lisa: Thank you. So I, I describe myself as a blend between an authentic leader and a servant leader. I think it's really important to. have a very team based collaborative approach and to have a very bi directional. To my kids, I'll say I'm a benevolent dictator because for obvious reasons they have to follow rules, right?

But in my work life, I think it's really important because I learn just as much from my team as I would imagine they're learning from me, right? So we need that bi directional communication. I had a colleague who used to say leader with a capital L. And I latched onto that because I think a lot of times we as leaders are placed in leadership roles or positions where we're not completely using our span of control for the very good, right?

So I think there are some particular examples where I may need to advocate for my team. Right? And I may need to climb the ladder or go across the organization or go toe to toe with another leader to say, no, this is really important. I'm not just asking for another staff member for no good reason. I have data behind that.

We have at risk moms are at risk Children, or we need to fulfill this contractual obligation to a partner or. And I have a legitimate reason for asking. I'm just not trying to get a bigger team. I think those are examples of how we as leaders need to engender the trust of our teams to know that as leaders, when appropriate, we can advocate with and for them.

[00:39:59] Jared: Absolutely. And another piece of leadership is fostering collaboration. And something that I think can be really difficult from somebody in a leadership position is there's all these people underneath you or beside you that they all have these stakeholders had different needs and wants. And how do you actually foster collaboration to where?

Everyone is actually underneath a unified vision and everyone gets behind it and they decide to push forward on it together.

[00:40:24] Lisa: So one thing I did with my, I have one of the larger teams that I've ever had currently. And one of the things that I did last year, New Year's, is that time, right? Everybody's making resolutions and thinking about New Year, New You.

Right. I tend to use New Year's on January as the time to set the stage for the year. And what do we want to accomplish together? And I force that with my team a bit and say, here are the objectives that have been handed to us, whether that's by a health plan or a position group or whatever it is, a value based contract.

But what do we really want to, like, give me more meat on those bones? What do we really want to do as a team? How do we want to contribute, put our own special touch on it, or spin on it, or even take it further? And exceed goals, or exceed targets, to take it into that next step. And I think spending that, just a couple hours, in that very beginning of the first quarter of the year is extremely valuable.

Because... It lets us all come together and hold hands around a shared vision, and then we can go back to that shared vision quarter over quarter as the year progresses.

[00:41:32] Jared: Now, I would like to look into the future and looking out to what's ahead. And yeah, there's always been, especially in the past, maybe like five years, healthcare has seen a lot of change.

And given your experience, where do you see population health going anyways, in the next decade? Because I think that's something that doesn't get talked about enough.

[00:41:48] Lisa: Yeah, I, I personally would love to see way more contracts become value based like I think we're doing well, but I want to see us just keep going right.

I want to see almost every contract have a value based component because I feel like everybody wins. Payers win if you control costs, physician groups win if you reward them for their good work, patients win because they're getting better care, health populations win, health outcomes win, because we're doing better work.

So that's one thing. The other thing is I do think AI and robotics are just going to continue and I Have spent a bunch of time in predictive analytics, so I think thinking about those models and how we put data together to be better predictors of who's going to go to the hospital or who needs more attention for their chronic disease or who may never fill a prescription because they have these five social drivers, right?

I think those are the hot spots moving forward.

[00:42:51] Jared: And with our final question of the day is. Just around a piece of advice for those that are coming after you, something that maybe you're very fond of telling people for the next generation of how do they can be as successful as you to get into the seat that you've gotten into.

[00:43:06] Lisa: Yeah, I encourage people to just keep having those conversations, right? Keep meeting new people. Stay open. You never know who you're going to meet or what their story is and keep yourself really broad based, right? The not easy answer is I am able to. fulfill one of my dreams to do population health work and not be a full time clinician.

Not that I didn't love it. I love my patients, right? But in order for me to make that transition, I had a lot of networking, a lot of exposure, a lot of questions that I was asking, and a lot of ways that I was trying to apply my clinical experiences on the front line to doing something new or different.

So I tell people, Just really be open and continue to do that networking and that exploration and be active. One of my earliest mentors said to me right out of school, don't just go to work and come home. Be an advocate for the profession, for health care. Participate. If you can't give money, give time. If you can't give time, give money so somebody else can do a political action, right, on your behalf.

But, I think those things are really important.

[00:44:19] Jared: Fantastic. Dr. Shock, thank you so much for your time. Thank you for joining us and just thank you for the work that you do. We're excited to see the impact that you're going to have throughout the rest of your career as well.

[00:44:28] Lisa: Thank you for having me.

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