Establish a Personal Health Record for each person in the U.S.– either via Private or Public means, if every person had a PHR that was maintained over a person’s lifetime, each person would own their own data and then decide who and how it gets shared, mined, used, etc. Microsoft Healthvault and Google Health maybe were ahead of their time when they introduced these concepts. I think this is the way it makes sense to make data more interoperable and sharable among those providers that patients believe should have access to it.
Asa part of my interview series with leaders in healthcare, I had the pleasure to interviewing Barbara W. Casey — Global Healthcare Leader, Cisco Systems, Inc.
Thank you so much for joining us Barbara. Can you tell us a story about what brought you to this specific career path?
Iwas in seventh grade and announced at the dinner table that I wanted to be an “organizational therapist.” You see, my mother is a child psychologist and my father is an attorney, so I sort of developed an affinity for the merger of business and psycho-therapy. Fast forward to my MBA program and at that time I was working at Marsh & McLennan (risk management, insurance brokerage) as a sales assistant. I had studied the consulting firm subsidiaries that Marsh owned at the time and I decided HR consulting would be ideal. After I graduated, I went to work for Mercer and ended up working in the Mercer Management Consulting group that focused on Healthcare Provider consulting where I was advising clients on Managed Care strategy. I built Provider-Sponsored HMOs from scratch and I was hooked ever since.
Can you share the most interesting story that happened to you since you began leading your company?
Coming into Cisco, I had spent all of my career in Healthcare Strategy and Operations — in one sense or another. I was a business-side executive and I’d worked with IT leaders to enable the business strategy. I was hired at Cisco to bring that “business-side” understanding to the technology Cisco sells — translate the horizontal technology into how it could be applied in a relevant, industry-focused way. For the first 2–3 years in this role, my voice was still very much “Line of Business”, because that is what I knew. In 2017, there were multiple leadership and strategic changes within our company. Chuck Robbins was about two years into his CEO role and there was a tremendous wave of innovation that had taken place and was being announced in the Cisco portfolio around Enterprise Networking, Data Center, and Security — our core business. In order to truly represent Cisco in the best light for our customers and authentically convey our value proposition in healthcare, I could no longer rely solely on my current knowledge base, and this made me feel pretty vulnerable. I was faced with a daunting challenge — either learn our core technology on a deeper level, or leave the company. So, I decided to really lean in and learn it. It was not easy but it has been extremely valuable and rewarding. I now have a much more informed point of view about HOW to make digital health a reality for my customers and clients, from the very foundation of the technology stack to the end-user experience.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
When I started out in management consulting, I was at the most junior level and my job was somewhat predictable, or so I thought. I did market research, prepared spreadsheets and pro formas, took notes, wrote documents and deliverables, and attended meetings. And, it went on that way for several months. One day, I was sitting in a board meeting with a large health system (on the side, not at the table) and my Partner asked me to provide a summary of the day’s meetings with the Health Plan we were meeting with. I was stunned, and speechless. I stammered and hemmed and hawed…basically was not prepared for this ask. And, then I felt horribly humiliated and wondered if I was going to be fired. I had made a mistake, for sure, in that I got a bit complacent. The lesson I learned that day is, if you’re in the room and you’re on the team, you’d better be prepared to say something and have a point of view.
What do you think makes your company stand out? Can you share a story?
Cisco is unique in the world of digital health as it is truly alone — there is no other competitor that has the same elements within its technology portfolio. We may have competition in a single architecture — Enterprise Networking, Data Center, Security or Collaboration — but no one has all of these in combination. So, when we’re striving for connected health, there is no other organization capable of delivering what Cisco can in terms of core infrastructure and platform capabilities, that can be built on top of to achieve amazing things.
There are many stories where this becomes important. One is where the “whole IT stack” is not considered and so expectations are not met. Let’s say a service line leader (e.g, Neurology), Physician + team, selects a point solution for telestroke. They do an RFP, they conduct a thorough search and they choose an application with many bells and whistles. As they implement, they see it’s not quite working the way they envisioned, and not even as well as it did in the demos. It’s slow, has poor video quality, it times out or it abruptly stops in the middle of a session. And, the mainly-clinical team who conducted the selection process is disappointed in the results and wonders why, but blames the application vendor. If they were to do a root cause analysis, they would discover that maybe the application was working just fine, but that their network was to blame, or the way the video was configured to run in their existing collaboration environment was not quite optimal. These types of digital solutions require a deep understanding of multiple technology domains to run effectively. In this example, Cisco has solutions and expertise to bring all of these domains to the table and to ensure they are working optimally to achieve the desired outcome.
What advice would you give to other healthcare leaders to help their team to thrive?
As it relates to developing and executing a digital health strategy, I would say diversity in the team is key. Diversity of knowledge, experiences, education, backgrounds, etc. is important to be able to leverage all the various components and perspectives of what needs to come together to be successful. For example, technical acumen, understanding of how a user experience happens in multiple industries, but also having a deep understanding of how healthcare works at a local level (even at a Global scale, how healthcare is delivered is a very “local” phenomenon, while solutions can transcend some of this nuance and be more widely applied), and cultural nuances of how different people seek and want to consume healthcare — all of these knowledge or experience sets are good to have in a team. So, the curation and cultivation of that diverse team is extremely important.
According to this study cited by Newsweek, the U.S. healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the U.S. is ranked so poorly?
1) Healthcare in the U.S. is a “cottage industry”– because we have more of a private system, we have many independent businesses that deliver healthcare, leading to less interoperability and more gaps in information and continuity across the continuum. As health systems consolidate, they need to figure out how to leverage the economies of scale they have as they amass a greater asset base.
2) Information is still in silos — because of the different, independent businesses, health care data and information is not interoperable, and doesn’t “follow the patient” — therefore tests are ordered many times, drugs are over-prescribed, costs are multiplied when a patient’s records cannot be accessed by multiple providers of care, and so until records can be accessed easily by all, and in a longitudinal and contextual way, our system will continue to demonstrate inefficiencies.
3) Providers have no true incentives to coordinate or manage care efficiently — Value-based payment and risk-based reimbursement still hasn’t resulted in payment mechanisms that change the Fee For Service (FFS) payment methodology. So, to the average physician, it doesn’t feel any different — you’re paid for what you do and generate in terms of volume. Until the FFS payment methodology evolves to more of a capitation type method, we may not see much change in provider behavior in terms of how they coordinate or manage care.
4) Does the U.S. spend more on R&D than other countries? If the dollars associated with research and development, clinical trials, medical devices and new pharma or biotech therapies are incorporated into our country “cost of healthcare” then it’s my hypothesis that we are likely to outspend other countries, and yet these investments benefit the entire world if they result in new drugs or treatment modalities. How is this spending being accounted for and allocated?
You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall U.S. healthcare system? Please share a story or example for each.
1) Establish a Personal Health Record for each person in the U.S.– either via Private or Public means, if every person had a PHR that was maintained over a person’s lifetime, each person would own their own data and then decide who and how it gets shared, mined, used, etc. Microsoft Healthvault and Google Health maybe were ahead of their time when they introduced these concepts. I think this is the way it makes sense to make data more interoperable and sharable among those providers that patients believe should have access to it.
2) Institute a basic level of health insurance coverage for all U.S. citizens — health insurance at a basic level should be affordable and available to all. Obamacare probably got us the closest to this one, but now has mostly been walked back…so what to do to make it happen? Not sure, but I believe each person should have preventative services covered (screenings, immunizations, basic diagnostics to gauge current state of health, other types of primary care) and then probably catastrophic insurance for trauma or emergencies.
3) Drive the right alternative reimbursement models to gain more care coordination and accountability –move beyond FFS payment, drive the concept of the Patient-Centered Medical Home (PCMH) and put accountability on whole provider systems or networks to manage dollars per patient across the continuum of care.
4) Create digital health capabilities for consumers that are at least “on par” with other industries — consumers/patients should be able to email or text their providers, make appointments online, compare prices for common procedures or tests, get prescription refills or lab results online, see clinicians remotely, via video or phone, get prescriptions delivered to their home, etc. Healthcare as a user should be as convenient from a digital perspective as traveling, making hair appointments, or streaming content. Excellent consumer service should be a goal for a physician practice — right now they are still closed for lunch (even to phone calls) and on Fridays. That’s positively “dark ages” as it relates to service.
5) Involve more roles in the “caregiving” process and offer more in-home support — if chronically-ill and elderly patients are consuming the most healthcare resources, we need to provide greater support as it relates to social determinants for this population. People don’t have to be nurses or doctors to provide outreach to those in need. They can be relatively inexpensive, but well-trained individuals providing different services that correlate to good health at home. For example, someone to make sure / understand:
a) the environment is safe from fall hazards,
b) the food and nutrition situation and needs,
c) the person’s social life — does this person have caregivers, friends, family, or are they isolated?
d) assessment of the person’s mental state, etc.
More and more studies are showing that we need to understand how to take care of the whole person (physical + mental/behavioral), and we could be using more and different less expensive resources to do just that.
Ok, it’s very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
Individuals– demand to be treated differently by healthcare providers! Review your physician practices, surgery centers and hospitals online, treat them as any other consumer business and provide feedback constructively to these businesses about how you expect to be treated and communicated with.
Corporations– create future-state strategies by envisioning what is possible. Make it as detailed and real as we can in terms of what the vision is. Then, create the organizational structure to make it happen. This is one of the number one barriers I see in our healthcare organizations today — they are relying on old, parochial paradigms in terms of how they are structured. They have no leader or function that oversees the consumer/patient/family experience across the continuum of care, even though they may own 80% of it! There needs to be a Chief Digitization Officer or Chief-someone who wakes up every morning thinking of how the customer journey unfolds from the doctor’s office(s), to the diagnostic/imaging center, to the ASC, to the hospital, and across post-acute care, back into the home. Are all those experiences seamless, frictionless? Do they have continuity? Is it easy for the consumer/patient/family to consume care in and across these settings? And, then when they are billed for services, does it make sense? Has everything been done to coordinate these motions so that it’s as easy as possible for the consumer/patient/family to do business with the corporation as the Provider or Payer? These are first order operational/clinical/financial goals of any corporation applied to healthcare today.
Communities — here, I guess it’s about outreach, outreach, outreach. And, communities need to take care of those that are inherently underserved when it comes to healthcare. When I was building Medicaid plans in Detroit or Arizona, we did a tremendous amount of research to understand the population and their culture. Where did they hang out? Where did they spend social time? What were their lives like? Once we understood these factors, we then created logical “moments that matter” in terms of outreach or education in places where they already were. For example, in Detroit, we put Medicaid enrollment centers in churches, barber shops, or WIC clinics. We did screenings and flu shots at county fairs and other highly-frequented sites in the community. Education sessions were done in public schools, starting in elementary grades about the important of nutrition and mental health, as well as primary care. This is a big one to tackle, so working across several public sector groups and like-minded community programs with an aligned goal of a healthier population is key.
As a mental health professional, I’m particularly interested in the interplay between the general healthcare system and the mental health system. Right now we have two parallel tracks mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?
I so agree! Remember how I wanted to be an “organizational therapist,” well I have an undergrad degree in clinical psychology. So, this issue is near and dear to my heart. I don’t believe the status quo around parallel tracks (mental/behavioral and physical) in our approach to care is sustainable. Realistically, there is no way to separate these two concepts. Many studies prove when people are diagnosed as mentally ill, they have a higher instance of physical illness as well. Conversely, when people contract life-altering physical diseases (such as cancer), they also experience major setbacks in terms of mental health as a result (depression, anxiety, isolation, etc.).
We need to promote a new design paradigm that is person-focused and behaviorally-based instead of the current disease-based paradigm. This new paradigm would drive sustainable behavior change for patients. Insights from behavioral sciences are used in retail, financial services and hospitality to influence how we buy, what we save, and other aspects of our behaviors. These insights are rarely used in healthcare, but if they were we could use behavioral segmentation or predictive modeling on cognitive biases combined with the clinical segmentation based on chronic disease risk to influence uptake of behavioral change.
A good example of this kind of model is a California provider that focuses on seniors. One of its primary goals is to encourage behavior changes crucial for effectively managing chronic conditions. This provider combines technological innovations, including electronic medical records (EMRs) and remote monitoring, with a wide array of nontraditional services (e.g., caregiver support, preventive podiatry, no-cost transportation to its offices, house calls by physicians and nurse practitioners, tailored fitness centers, and an intervention team that goes to patients’ homes to investigate nonclinical problems). The provider reports that its risk-adjusted costs are 15 percent lower than the regional average for comparable patients and its clinical outcomes are above average. For example, its amputation rate among diabetes patients with wounds is 78 percent below the national average, and its rate of hospitalization for end-stage renal disease is 42 percent below that average.
How would you define an “excellent healthcare provider”?
An excellent healthcare provider demonstrates excellence in clinical outcomes, innovation, operational effectiveness, and financial clarity/transparency.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“Do not feel lonely, the entire universe is inside of you.” — Rumi
As a practice, I am dedicated to “communing with myself” on a regular basis (daily), so that I am always authentic in my intentions, interactions, decisions, and the way I live my life. I meditate each day first thing when I awake. As we all do, I play many roles — wife, mother, daughter, leader, friend, etc. — and I want to show up in these roles as the best possible version of myself, so that I can serve others in the best way. I know and understand that self-care comes first, only so that I can be there in as much capacity as possible for others. As a leader, I am a servant to my team. I definitely work hard for them, so they can be as successful as they can be.
As a mother, I want to be an example of an “authentic life” for my children. I never want to “play it safe”, to “coast” through life or sell out in any way. I want to live out loud and take risks, I want to be fearless to do and achieve anything that I believe in with conviction. I want to be 100% me.
Are you working on any exciting new projects now? How do you think that will help people?
One of the most exciting projects our team is working on is with HIMSS Analytics around their INFRAM — Infrastructure Adoption Model. This project represents a collaboration between HIMSS Analytics and Cisco and the goal is to help healthcare organizations understand what levels of infrastructure they need in order to achieve higher-order business or clinical capabilities. As I explained in another answer, unless the right networking, security or data center solution and architecture is in place, the clinical and business applications or solutions will not perform as intended, period. Therefore, the INFRAM helps to create that linkage between infrastructure and clinical/business operations performance and raise awareness of the respective leaders that you cannot have one without the other. More information about INFRAM can be found here.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
Anything by Simon Sinek or Brene Brown. They just provide good leadership basics. Anything by Patrick Lencioni — Patrick’s “Five Dysfunctions of a Team” was a book that really helped me understand how to create, develop and lead a team. Whitney Johnson — Disrupt Yourself and Whitney’s podcast series — “Build an A Team” — https://whitneyjohnson.com– I love Whitney! Her podcasts and guests are great and a source of diverse thinking and advice. Recently one by Liz Wiseman on “Multipliers” was very interesting. Venture Valkyrie — Tech Tonics: The Podcast — https://venturevalkyrie.com/the-tech-tonics-podcast/– Lisa Suennen is a great voice within our industry, not to mention a mentor and a friend.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be?
I am such a strong believer in mindfulness meditation and its ability to holistically affect our lives — reduces stress, enhances focus, helps you sleep better, control your emotional responses, keeps you healthy in terms of mind, body, spirit, etc. It is a skill that when people possess it and regularly practice it, it changes their lives, and thus provides ideas that change others’ lives. I know this isn’t a new movement, and that there many are proponents — Arianna Huffington, Oprah Winfrey, Bill Ford, Marc Benioff, Jeff Weiner, etc. — so I guess I would propose to “pile on” and try to expand its use by teaching it in public schools and to kids at a young age.
How can our readers follow you on social media?
Blogs I author on Cisco.com– https://blogs.cisco.com/author/barbaracasey