Colleen A. McGuire of Silver Fern Healthcare: “Even more catastrophic is the lack of long-term care options”

I would increase the focus on whole-person health, including behavioral health. The industry is missing the most important pieces of the puzzle: individual behavior and social and environmental factors account for 60% of health and wellbeing. Healthcare industry investment and innovation are focused on medical protocols and devices, surgery, and prescribed drugs. These drivers only […]

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I would increase the focus on whole-person health, including behavioral health. The industry is missing the most important pieces of the puzzle: individual behavior and social and environmental factors account for 60% of health and wellbeing. Healthcare industry investment and innovation are focused on medical protocols and devices, surgery, and prescribed drugs. These drivers only account for 10% of health outcomes. If we want to improve outcomes, we must transition our approach to whole-person care and see the people inside the patients.

As a part of my interview series with leaders in healthcare, I had the pleasure to interview Colleen A. McGuire, Co-Founder and Chief Executive Officer, is a transformational leader passionate about healthcare reform. She brings more than 35 years of experience leading and mobilizing teams and organizations to deliver breakthrough results and create positive social impact.

Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?

Silver Fern Healthcare is a mission-oriented social enterprise company. For my Co-Founder, Garry Welch, PhD, this is his life’s work. He spent 20+ years developing a break-through methodology for treating diabetes and other chronic diseases. My involvement was personal. Earlier in my life, I knew someone who lost his life to a diabetes-related complication when he was only 35 years old — and that doesn’t need to happen. It shouldn’t happen. Diabetes is a disease we can manage. We have the knowledge to keep people healthy, but as a society, as a healthcare system, we’re simply not getting it done.

When we started Silver Fern Healthcare, there were about 26 million people in the United States with diabetes, and that’s only a few years ago. Today, there are more than 34 million people with diabetes and about 88 million people with prediabetes. As a society, we’ve created more medicines and we do more procedures, yet we’re not improving the health outcomes of people with diabetes. We still have very low rates of people who are meeting all the national guidelines for good health outcomes in diabetes care. In 2013, Garry reported out yet more proof, from a big NIH RO1 study, that we could improve this issue. At that moment we felt, not only compelled, but that it was our responsibility to get this science breakthrough and methodology to the market!

Can you share the most interesting story that happened to you since you began leading your company?

A company’s first sale is an important benchmark. For us, our first order happened to be 10,000 miles away, in New Zealand. They have a very different culture and approach to healthcare, so they immediately saw the value in what our evidence-based digital platform offered. We wanted desperately to fulfill that order, but the business wasn’t in a position to do so at that time. Everything was ready to go, but we just couldn’t execute on it due to the great divide in geographic distance and time zone differences. It was disappointing at the time to have to walk away knowing that execution would be problematic without a local partner and from halfway around the globe. The good news is that we’re ready to go back, post-COVID.

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 we rebranded, we ordered all new business cards. I was so captivated looking at our new logo and beautiful new card, I didn’t notice that my title was listed wrong. I was handing them out for a week before someone alerted me to the fact that they said, “Chief Scientific Officer.” It made for some great laughs. In a startup, the CEO takes on nearly every title in the company, but that’s probably one of the functional areas for which I am least qualified!

What do you think makes your company stand out? Can you share a story?

Silver Fern is differentiated in the marketplace because it has been proven through strong, proper clinical research. Many companies create a product and then try to prove that it works. Silver Fern’s Behavior Diagnostic Platform was proven through robust clinical research before it was brought to the commercial market. This gives us a major advantage over other products or digital health platforms out there. Our product is also substantially different from any other product on the market today because we are the only company comprehensively addressing all of the behaviors and psychosocial factors impacting health outcomes for individuals with lifestyle-related chronic diseases. Many other companies address one or a few factors. Our platform is extensive with quick screening questions and thousands of suggested actions to help clinicians care for patients. Our model acknowledges and embraces the importance of the relationship between a healthcare provider and a patient. The provider must know the patient’s story; that’s where the traction is. And that’s the reason why many nurses and health coaches get into the business: to help patients. To accomplish that, they have to take the time to get to know them and build trust, and our platform helps them to do that in a systematic and efficient way.

The stories that stand out to me are the words of our users — health coaches, nurses, and diabetes educators. We hear stories everyday about the impact on the patients as well as how the platform has changed the way our users approach their work. We now have heard dozens of stories about patients for whom our platform has been life changing, even life saving!

What advice would you give to other healthcare leaders to help their team to thrive?

First and foremost, you need to take care of the team. Let them know that they are your most important asset, that their voices are important, and that the work they do every day is valued. And take care of them by investing in their growth. Second, a company and its team will thrive if they come together behind their mission. People want to believe that the work they are doing is important. When a leader drives the company and makes decisions with the mission at the forefront, the team is better coordinated and more invested in the work they are doing. Additionally, you need to provide transparency in your decision process and day-to-day activities. And, perhaps most importantly, make work fun!

According to this study cited by Newsweek, the US 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 US is ranked so poorly?

Our ranking is easy to explain: our healthcare is the most expensive, but our outcomes are near the bottom. I believe this is primarily true for the following reasons:

The incentive structure in healthcare is broken. The fee-for-service model doesn’t prioritize health. If we want to reduce cost and improve outcomes, we must make a concerted effort to move to a value-based model and begin prioritizing individual and population health as well as prevention.

Today’s healthcare system is fragmented. There’s no coordinated care, which drives inefficiency and poor patient experience.

Fundamentally, if we want to see comprehensive improvement in our health as a nation, our culture and lifestyle habits must change as well. This change can be supported extensively by the healthcare system, but our US healthcare system is not currently adapted to focus on prevention or disease management, it is instead mostly focused on acute care needs.

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 US healthcare system? Please share a story or example for each.

I would increase the focus on whole-person health, including behavioral health. The industry is missing the most important pieces of the puzzle: individual behavior and social and environmental factors account for 60% of health and wellbeing. Healthcare industry investment and innovation are focused on medical protocols and devices, surgery, and prescribed drugs. These drivers only account for 10% of health outcomes. If we want to improve outcomes, we must transition our approach to whole-person care and see the people inside the patients.

I would add more resources for primary care, which is where most people with chronic conditions are currently treated. The primary care system is enormously overburdened. Primary care needs the support of an extended team of professionals that can help to provide coordinated care for patients.

I would accelerate the move to value-based care to better align the system incentives with patient health outcomes.

I would leverage digital technology, including permanently blending in-person care with telehealth and ensuring better interoperability and data sharing.

I would improve access. We must treat healthcare as a universal right, so that people can receive the education and resources to remain healthy, rather than treating them in our emergency rooms.

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?

Get educated and start eating better (individuals — supported by government, communities, employers, providers, and families)

Provide universal healthcare (government)

Provide transparency on pricing (hospitals, providers, and other healthcare service providers)

Continue to transition fee-for-service payment model toward value-based care payment models (industry, leaders, and government)

Increase public and private investment in digital technologies and innovations that focus on the biological, psychological, environmental, and social factors impacting health (all stakeholders including government, corporations, and individuals)

Create programs and incentives to increase the number of health coaches and wellness programs available to provide preventative and chronic disease management support (government, communities, employers)

Increase the number and quality of behavioral health programs to help address the massive mental health issues that are only getting worse with COVID, including offering new digital behavior health programs and telehealth appointments (government, communities, hospitals, and providers)

I’m 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?

The system is currently broken. We never should have unbundled behavioral health because it is deeply interconnected with physical and general health. Providers need to recognize the symptoms and have the tools and resources to support patients. The first tool they need is a universal, systematic, and comprehensive screening to help them properly diagnose and refer patients.

Even more catastrophic is the lack of long-term care options. If you have a severe psychiatric condition, your only option for treatment is to go to the ER, and even then, you need to prove that you are a danger to yourself or others for them to admit you. Without help, many of these people are driven to homelessness. In terms of suggestions, this is a monumental problem, one requiring vast resources and an “all stakeholder focus” to come together on whole person care and to deal with the systemic challenges for people with mental health problems and the challenges that mental health places on families and society.

How would you define an “excellent healthcare provider”?

An excellent healthcare provider is someone who can build trust with the patient by understanding and treating them with compassion. When they look at patients, they see them as individuals, with unique barriers, goals, and preferences for treatment. Unfortunately, good people are often constrained by challenging environments, so in order to be excellent, the system must provide them with the training, tools, time, and team to do all of these things well.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

One of my favorite quotes is by Margaret Mead, “Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has.” I believe it is extremely important to set your sights high. You are the only one limiting what you can do, so always set your sights high.

Are you working on any exciting new projects now? How do you think that will help people?

We have some exciting things happening right now at Silver Fern. We recently launched an incredible new feature of our dashboard called “Suggested Actions.” These are evidence-based clinical actions that have been used successfully by clinicians with patients to address their individual needs and challenges. Within our dashboard, these actions are tailored to provide guidance and ideas for the specific experiences, behaviors, goals, or barriers illuminated about each patient by Silver Fern assessments.

We are also really proud of some of the population health insights that we are uncovering with our platform. Because we are helping to systematize best practices for behavior and psychosocial assessment and treatment, we are collecting never-seen-before insights into population behaviors and barriers. For a long time, the healthcare system has focused on biometric and laboratory metrics when talking about health and treatment. There’s now been a shift. Now more people and industry leaders are looking to do the same thing with behavior and psychosocial insights — that is helping to drive the conversation toward whole-person care.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

The books that have inspired me as a healthcare leader are Vivian Lee’s, The Long Fix and Elisabeth Rosenthal’s, An American Sickness. These books challenge us as healthcare leaders to be better and to do better. In terms of running a healthcare business, I was most influenced by Christensen, Grossman, and Hwang’s, The Innovator’s Prescription: A Disruptive Solution for Health Care. It helped me to understand where innovation and disruption fit into our goliath healthcare system and create a vision for how our company could help the system shift toward a focus on value and patient health. It was a long time ago that I learned from Heskett, Sasser, Jr., and Schlesinger’s, The Service Profit Chain, the importance of taking care of your people. It became so obvious to me that if you are in a service industry or a mission-driven endeavor, your people are your most important asset. If you pay attention to you people, they will do a better job for you and your clients, and in turn, you will have a happier workforce, happy, loyal clients, and a stronger bottom line.

If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger.

I think that’s exactly what we are trying to do with Silver Fern! We are trying to change the system’s entire approach to care to focus on the whole person, not just their acute issues, biometrics, and medications. To help patients prevent disease and achieve better health, we need a coordinated, comprehensive approach to care, and the care equation needs to focus more heavily on the biological, psychological, environmental, and social factors impacting health, including putting true behavioral health back into the equation. We are trying to get this message to the healthcare system, but also to the world.

How can our readers follow you online?

Our website is The best way to follow our work is on LinkedIn. And I encourage everyone to sign up to receive articles and blog posts from our Insights page. We are committed to developing meaningful, well-researched content that speaks to many of the themes we’ve explored in this interview, and much more. Our most recent series of articles focused on diabetes distress, a common but not well-known symptom of diabetes that often is misdiagnosed or mistreated as major depression.  

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