The Value-Based Healthcare Podcast - Episode 24: The Silver Linings of the Pandemic and How it Will Improve Healthcare

Introduction:
Welcome to Reveleer Value-Based Healthcare Podcast. In every episode, we discuss healthcare technology, innovation, and current events, presenting interviews with the thought leaders from a variety of disciplines of healthcare. Don't miss any episode by subscribing to the series via reveleer.com. And now here's our host, Jay Ackerman, introducing today's guest.

Jay:
Welcome to a new episode of our podcast. With me today is Meera Mani. Hello, Meera, and thank you for joining us today.

Meera:
Thank you for having me, Jay.

Jay:
So how about a little background on Meera. Meera is a partner with McKinsey's health systems and services practice in New York. She spent a decade working with leading healthcare organizations on strategy and performance transformation. Her client's services include the topics of growth and innovation, technology-enabled business model transformation, transition from fee for service to value-based payment models, a personal favorite of mine, program integrity and M and A. Meera also leads McKinsey's state health and human services domain nationally. In addition to our client commitments, she's a member of the CCI chief medical officer round table and serves on the board of the United Hospital Fund. And prior to joining McKinsey, Meera was a physician-scientist with a doctoral thesis in biophysics. She received her MD and Ph.D. in biophysics from Cornell University Weill Medical College, and she received a BS in biochemistry from Rutgers. Welcome again, Meera. Why not spend a minute or two talking about your operating model during the pandemic? So, how have you kept your consulting practice at McKinsey thriving through this period?

Meera:
Well, 2020 has been an extraordinary year by any measure. The client need for our research and expertise during this period of uncertainty has been unprecedented. To contribute to some of the public and the private response to the pandemic, we created the COVID-19 response center. The intent was to make research, data visualization, and some other resources available publicly and quickly. There's been really good uptake of some of that information, our articles have had more than 25 million views. One of the things we wanted to do is to be able to apply our experience as a global firm, 130 offices, 65 countries to gather and share some of their relevant insights and learnings to manage the pandemic response. So, in the early days, for example, as we saw China close down and come back up, there was active interest in learning what was happening in other parts of the country and the world in order to really take stock of where we are and mobilize on what do you do next.

When I think about internally, so that's on the client side, and think about internally, as a consulting firm, we are accustomed to working remotely. We had the tools and the technology to shift fairly quickly, I would say, and effectively to working remotely and getting off the road. And the workforce across all tenures was agile in adapting to that. I'd say driven by the client need we've maintained or increased recruiting across roles and across geographies. I think we've had to double down on ways to engage colleagues, some of whom have never set foot in a physical office. So how do you engage a whole group of new joiners? It just means a lot more virtual town halls, a lot more community chats, and a lot more poll surveys.

A couple other things I would note, the Zoom fatigue is very real, as are some of the broader mental health issues. Just folks trying to find meaning and exhausted. So, we're working to provide additional support to really help folks stay connected, while staying safe. It was a year with many challenges but personally, I'm really thankful and optimistic as we close out.

Jay:
Anything that you can share that you've learned about yourself and working through this pandemic?

Meera:
Yeah. Many folks I work with say that both their colleagues and clients say that reducing the time spent on the road, getting from place to place, has really improved their productivity, has allowed them to spend time at home with their families, and possibly extend their consulting career, because often the travel is sometimes the undoing for many road warriors. The work from home has its challenges, but can create a close connection in a different way than a coffee or a lunch. So, there's a Zoom call that shows you in your home, surrounded by your pictures, sometimes interrupted by a child or a loved one or a pet. It just puts you in a different light than it than it might if we were having coffee or something.

So that's been, how do you find meaning and connection in a different way? And the third thing I would say is, closer to home, it's been really gratifying to see how resilient and adaptable my family has been. I have two elementary school aged children. They have never experienced anything like this before. And they're absolute champs when it comes to mask wearing and physical distancing. I don't have to tell them twice and I'm just amazed and inspired. And I'm like, "If they can do it, so can I."

Jay:
That's great. Thanks for sharing that. So let's talk about how you entered healthcare.

Meera:
I grew up in India, in a family with educators, doctors, and researchers. So, in a way, healthcare was my default from the get-go. And that held even after I moved to the United States to go to college. And I think I authentically, I loved all of it. I love all of it. So, the issues-based problem solving, this idea of helping people get well and stay well, the research part which is really self-propelled discovery, that's essentially for me, basic research. And then over the past decade as a healthcare consultant, applying that clinical and research training to work on system level improvements. So, it started as a default but it's been an enduring love and it's taken many forms, but it's always stayed within healthcare. And I traveled far and wide within healthcare, doing lots of different things across the value chain because I find it incredibly fulfilling and interesting.

Jay:
So maybe just staying with that another minute or two. You went to medical school, but now with McKinsey. So maybe take us to the step to join McKinsey. And you've been there now for a while. What is it about that environment and the way you're able to impact people and companies that's kept you interested and excited?

Meera:
Yeah. My experience at McKinsey, and I've been with the firm for over a decade now, has really mirrored the evolution we've seen in healthcare in the United States over this past decade. So, think the expansion of coverage that happened through the Affordable Care Act, which essentially took down the number of people who are uninsured down from over 45 million to 29 million or so. The state-wide consolidation that we've seen, the exponential growth that we've seen and urgent care, and now virtual care, the emphasis on social determinants of health. And then overall just the change in business models have all been central to my own journey within healthcare.

I have been working with public and private sector clients with the boards, with senior management teams, with agency leaders, as they innovate, as they transform, and as they shape these changes. I tried to ask two questions for all of the work that I do. The first is, am I applying my skills, my experience, and my network to the best possible use? And the second is, how is whatever it is we're doing, making healthcare better for the recipient? I think those are some of the guiding principles or questions that I try to keep in mind across the entire portfolio of work that I do.

Jay:
That's great. Thanks for sharing that and how it kind of shapes the way you operate. So, let's talk about industry trends that you see as beneficial to healthcare. And then in the role you sit in probably not a better person to ask that question to right now.

Meera:
I would point out probably six or seven things, and many of these have been accentuated and accelerated by COVID-19. But for brewing, I would say to begin with. The first is, you begin with the recipient, with the customer, the consumer. They're demanding increasingly the affordability, the transparency, and the experience that we/they have it in other parts of our life. You see this, when you see the adoption when the exchange opened up as essentially a new market to purchase health insurance, we saw the adoption of cost competitive narrow network products on the exchange. That's people voting for affordability with those choices. We see that in the adoption of urgent care and now virtual care. So I think there's just a growing emphasis. And a lot of this is also supported by offers from both incumbents as well as new entrants that actually provide that value proposition and that convenience to customers.

The second thing I'd call out is the coverage ships, the growth in government sponsored segments, Medicare, Medicaid, and the exchange that are driven by the demographics and by policy action are ongoing trends, and through COVID. The third is a shift away from the hospital and into the home, into the community. This is pushed by advancements and pain control. And in minimally invasive surgery, it's pushed by consumer preference. It is supported by price difference. And there's also aligning incentives with physicians to provide care in the most convenient and effective setting. And a lot of this is accelerated by COVID-19 because we've had to adapt. The next thing I'd emphasize is just the reduction in stigma resulting in a much greater focus and recognition of behavioral health conditions, mental health, and substance use disorders, and an emphasis that the integrated care, integrating physical and behavioral healthcare is a critical unlock to achieve greater improvement in cost, as well as an imperative.

We're seeing increasingly inpatients with the high friction manual inefficient healthcare paradigm that we should expect is increasingly disrupted by the use of technology. In some cases, by the leading technology companies and other cases by incumbents in healthcare. The couple things I would wrap up with are, the growing awareness and urgency that we need to address, inequities and racial disparities in healthcare. That's come into very acute focus as we think about the world we live in now. And the final thing is the sector consolidation. In the midst of all this, we're seeing sector consolidation that continuously raises the bar for the minimum scale to remain competitive.

Jay:
That's a healthy list.

Meera:
I tried to keep it to seven.

Jay:
Yeah, no, and they're all important. What do you see as the greatest challenge that you continually encounter in healthcare?

Meera:
I think that our three areas that come into focus. I think number one is the healthcare infrastructure that is demonstratively susceptible to shocks, COVID-19 has taught us that whether it's the public health system and the data reporting, as we're learning, or it is the primary care delivery system, particularly in rural areas. In an international survey we did, for example, close to half were concerned that we surveyed physicians and close to half were concerned that their practices might not survive COVID-19 and a good third we're considering retirement. It just was untenable. So, it just goes to show how vulnerable some of that essential healthcare infrastructure is and the work we have to do to strengthen it. That would be first. I think the second is the access. There's still an unacceptable number of folks, 29 million folks that remain uninsured.

And if you click a level deeper, even if you did have coverage, doesn't mean you have access to care. Some folks like those with intellectual developmental disabilities have to wait months, if not years, in order to obtain services. It takes like on average three weeks to get a behavioral health intake appointment. So, we have a coverage issue and we have an access issue that we need to confront and manage. And the third thing I point out is the affordability. The affordability challenge, the cost trajectory of healthcare is outpacing wage growth. That just fundamentally is untenable. And it's going to create continued pressure to get the costs in line and to improve affordability.

Jay:
Maybe we can double-click on that last point. What do you see out there that can have the biggest impact on taking the cost curve down?

Meera:
I think that the innovation and the use of new modalities, the meeting consumers, where they are, the focus on integrated care, the focus on staying well, not just getting well, once you're sick. I think these are all really positive changes that can support better value in healthcare. I think also, it's important to make sure that in the midst of offering the convenience, we don't swing towards too much fragmentation that we continue to maintain an integrated view of what care is, or is not needed through data sharing and through the appropriate information exchange through engaging consumers in their health care, to make sure that all of the care that's delivered is truly to support value and ultimately affordability.

Jay:
Why don't we talk about your practice a little bit? And so, the challenges you just highlighted, can you share what you're doing and maybe what you and some of your colleagues are doing to help health plans and health systems address some of those challenges?

Meera:
Sure. So, there are about a few different areas that we've been focusing on. I think the first is, there's been a lot of work in the category of planning to navigate the uncertainty, this is going to stay with us for some time. So, there's been a lot of work that we've been doing on forward-looking intelligence, scenario planning, and identifying some decision points for action. I think it requires, some use the term ‘war room’ type of approach, to really take stock of the situation, pivot, monitor, and pivot as needed. So that's, I think the first thing. I think the second is, there's a lot of constructive reflection and challenge to the existing paradigm. What's the role of any given company or entity or agency in healthcare? How can we use this opportunity to really transform and make the changes that we've long sought? So that's sort of in the category of just rethinking the paradigm.

Related note. How do you never let a crisis go to waste? Make two cycle moves to emerge from COVID-19 as a healthy and sustainable enterprise. That will be the third. I think the fourth is the category of COVID speed. So, we've learned and adapted to make decisions quickly in the face of uncertainty. How do we maintain some of that agility as the next normal? And then I think the final is a lean forward on health equity. I think there's, again, brought into sharp focus by COVID-19 the disproportionate impact it has had on low-income neighborhoods among certain groups, African-Americans. So, a real opportunity to take stock of the inequities in healthcare, and to make change happen.

Jay:
That's great, thanks. I've been dying to ask one question kind of throughout. And so, you've mentioned the exchange a few times and how it's driven the uninsured population down. And obviously, there's a lot of talk about under the current administration around trying to dismantle it. What's the one thing you think we got right with the affordable care act?

Meera:
Personal view, that between the forming of the exchange and the expansion of Medicaid optional to States, of course, we have 16 million fewer uninsured people today than we did before.

Jay:
Yeah. Perfect. Yeah. That's a pretty easy headline to get behind. In your role, I imagine you get to see a lot of innovation taking place across the healthcare ecosystem. What innovation are you most excited about right now that you see unfolding?

Meera:
I think three things I'm struck by. I think the first is some of the breakthrough innovations in cell and gene therapy and in vaccines, the pace at which we've been able to develop an entirely new MRNA based vaccine modality and get it out to people within a year is just remarkable and inspiring. I think there's a price tag associated with these and so the challenge and the opportunity is really figuring out how to make these affordable and to provide access to these in an equitable way and not leaving people behind. So, I think that's one. I think the second is, I alluded to this earlier, so telehealth will hopefully become more of the norm. We need to work out how we continuously deliver high quality virtual care that is convenient, how we combine it effectively with necessary in person interactions and how we make sure that the sum total of all this actually leads to higher value and integrated care versus more fragmentation.

And then the third thing I'd point out is, there are broader changes in our economy and how we work so gig economy, growth of digital nomad. So, point being, if how we live and how we work is changing, then how we want health and getting well and staying healthy and what we expect from our healthcare will also change. And so that's going to be important to work out. How do we meet different groups of people, where they are, and keeping in mind how they live and how we expect them to live and work.

Jay:
That's great. All right. This one's an easy one for you since it's probably what you do kind of day in and day out. What advice might you have for healthcare executives in navigating the industry during these tumultuous times?

Meera:
Yeah, I think it's really around those themes of not letting the crisis go to waste and really using it as an opportunity to rethink the paradigm, rethink the business model, maintain the agility and the speed. It is the continued focus on planning to navigate the uncertainty. And it is on the health equity, really taking the opportunity to lean in, lean forward on health equity.

Jay:
Super, and transitioning to the individual, the insured member. What advice would you have for the public regarding the empowerment and ownership of their own health and wellbeing?

Meera:
I think it's continued to vote with one's feet and with one's wallets for convenience and for affordability, and through ballot, for convenience and for affordability.

Jay:
Yeah. Super. Well, Meera, you've been a wonderful guest today, so thanks for carving out time from a very busy schedule.

Meera:
My pleasure.

Jay:
But before we let you get back to your valuable work, let's conclude with a rapid-fire round. So, five quick questions. What keeps you up at night?

Meera:
Social unrest and polarization that we're living through now in this country.

Jay:
Yeah. Yeah. That's a heavy one. And so, when thinking about that at night and restless, what book might you grab from your nightstand and why are you reading it?

Meera:
So the design and architecture books, both the coffee table books and the magazines are very therapeutic.

Jay:
I bet they are. All right. How about favorite app on your mobile device?

Meera:
So the health app, of course, and then the streaming services are a close second.

Jay:
Perfect. Oh, I saw Calm yesterday had raised a big round and I think two and a half billion-dollar valuation. So, it shows how much people are relying upon some applications like that on their phone, from mindfulness and their own behavioral kind of health.

Meera:
Exactly.

Jay:
Yeah. How do you invest in yourself?

Meera:
I think there are time blocks every week that are the think time, me time blocks. And I think there's only certain activities that qualify to go in there. It has to be fun, professional connections and conversations like this one. It has to be uninterrupted reading or truly me-time and nothing else.

Jay:
Beautiful. What's the most creative thing that you've done during this stay-at-home period?

Meera:
I’ve created some new norms to stay healthy and to encourage my teams to do the same. So, I do a couple of things. I pace around my apartment to get my footsteps in, with a virtual background so I don't make others dizzy. And I do my conference calls running in the park.

Jay:
Beautiful.

Meera:
Sometimes you do what you have to do to stay fit and healthy.

Jay:
Yeah. I'm focused on my own physical wellbeing as well as mental. And they kind of go hand in hand and my Fitbit is something I live by. And it's one of the few upsides of this lockdown is my average number of steps per day is probably up 40%.

Meera:
There are ways to make it happen.

Jay:
Exactly. Well, Meera, thank you for joining me today. I really appreciate it.

Meera:
Thank you for having me, Jay. It's always great to talk to you.

Jay:
Thank you. This will bring our Value-Based Healthcare podcast to a close. You can follow us on Facebook or Twitter, and you may also follow me on Twitter at @Ackerman Jay. Over and out.

Outro:
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