Access is a big problem. There are so many uninsured Americans right now especially when compared with other countries that have some sort of universal health care program, which eliminates that access issue or at least reduces it by a great degree. So, I think that that’s probably the biggest driver of a poor U.S. ranking.
Asa part of my interview series with leaders in healthcare, I had the pleasure to interview Anthony Gabriel, MD.
Dr. Gabriel graduated with his medical degree from The Ohio State University College of Medicine and became a clinical instructor at UCLA Medical Center in 1993. While a practicing physician, he earned his MBA from the University of California, Los Angeles, Anderson School of Management and then joined DaVita Inc. During his time with DaVita, Dr. Gabriel was promoted from Vice President, Commercial Patients to Chief Operating Officer, overseeing the integration of Gambro Healthcare, which doubled the size of DaVita. In 2008, he rose to the position of Chief Information Officer leading 1,000 teammates, 300 contractors and overseeing a 150 million dollar budget developing several new systems for DaVita. Then in 2012, together with Rich Whitney, Dr. Gabriel cofounded Radiology Partners.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
I wasn’t planning to get into an administrative leadership role. I planned to be an interventional cardiologist. During my training at UCLA, I was on the wards and my attending physician was also the chief information officer for the UCLA Medical Center.
I learned about what he did every day. Much of his time was spent on non-clinical work. The direction he took interested me since I studied computer science in college. I actually ended up doing an elective month with him and some of the other administrative physicians at UCLA. And as I learned more about what these physicians did, I saw how improving processes and improving the organization can have an even greater impact on more patients than an individual doctor. Rather than being a great clinician and taking care of patients individually, which is what initially drew me into medicine, I saw I could impact more patients by improving the system. That’s what drew me out of practicing medicine and into healthcare management. I practiced for about ten years after my residency, but only a few years into practice I got my first real business job at DaVita., I spent about 15 years there before founding Radiology Partners.
Can you share the most interesting story that happened to you since you began leading your company?
Of course. First, we refer to ourselves as a medical practice, not a company. This reflects our focus on patients and their care.
A really interesting story that is illustrative about what we’re doing at Radiology Partners, began as so many good stories do, at a dinner about five years ago. I was with our CEO, Rich Whitney, and a physician candidate who now works with us at RP. As a final step before making him an offer, we were having a conversation over dinner about RP, our mission and what we’re all about. The candidate was asking us about one of our main principles at RP — One Practice, Locally Led. It means that our local leaders make all the decisions about how to run their local medical groups. We are a large physician practice with about 1,500 doctors but we’re organized in about 45 different local groups. Each of those groups has their own local president and leadership team that manages local finances and operations. He was surprised and kept asking: How can you guys let this happen? How can you let these 45 groups call their own shots? You don’t check their decisions? How can that actually work?
Rich and I said that local leaders are the best people to make those decisions; they’re closest to the action; they should be the ones making decisions. I remember him asking: What if they make a mistake? And our response was that people — even physicians — make mistakes, but these local physician leaders are much less likely to make a mistake than I am sitting in our business office in California.
This was one of the big questions he had to understand before he would join RP. And sure, we have systems in place to communicate and stay engaged with our practice partners, but local leaders are responsible for leading their local group, just as they did prior to joining RP. That dinner and discussion around the importance of local physician leadership has stuck with me all these years, and our One Practice, Locally Led principle remains central to our operating model.
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?
In the transition from being a practicing physician to a manager, I learned the way to be most effective revolved around my team and not just me. As a physician, you’re taught you are the person that has to do everything — you’re expected to make the decisions, and you’re held accountable for your choices. As a physician, you are really driving the train.
Now, over time, I’ve learned the less I do the better the organization does. My job is not to do everything. Every week I reflect on what I accomplished during the week and how I spent my time. I actually check to see how many tasks did I do versus how often did I support what others accomplished? If I end up having to do too many things myself, I know I’m doing something wrong and need to recalibrate and do a better job empowering and supporting my colleagues’ ability to get things done. I guess it’s not a funny story, but I think it really speaks to my transformation from a physician to a manager.
What do you think makes your company practice stand out? Can you share a story?
One word: culture. We spend a lot of time thinking about our culture, reinforcing it, and spreading it throughout our organization. When groups decide whether they want to join RP, the very first thing we share with them is information describing our culture. We do the same thing with prospective hospital clients. We talk about our culture first, not economics or operational capabilities. We talk about culture so much I sometimes question if people are getting sick of it. But that’s when you are doing it right, when a portion of your audience thinks you are being repetitive.
The reason culture is so important is that it enables people to make decisions when there isn’t necessarily a playbook to make those decisions. You have principles, values and mission that are all woven together to give a local leader an important guidepost. I have to operate within those principles. So, culture enables a lot of things to happen without necessarily describing detailed processes. And I think that enabled us to grow quickly, to be able to build capabilities and really be successful.
What advice would you give to other healthcare leaders to help their team to thrive?
Physicians can do more than provide clinical work. I see a lot of organizations that view their doctors as only those who take care of patients, while there is this separate group of non-clinical teammates making business decisions. I think that wastes one of the most valuable aspects of human capital an organization has. We have 1,500 incredibly bright, committed, hard-working physicians who know radiology very well. They have a passion for taking care of people, and they want the business to work well too.
Sometimes these physicians benefit from formal leadership development education they didn’t get in college, medical school or residency. Investing in that training is all upside since physicians have so much value to add. Engaging and developing leadership skills for those physicians can really improve the healthcare system overall.
Ok, thank you for that. Let’s jump to the main focus of our interview. 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?
First, access is a big problem. There are so many uninsured Americans right now especially when compared with other countries that have some sort of universal health care program, which eliminates that access issue or at least reduces it by a great degree. So, I think that that’s probably the biggest driver of a poor U.S. ranking.
But I want to give the U.S. healthcare system credit too. There still are people from all over the world who fly to the U.S. to get care. I can remember when I was at UCLA seeing the amount of people who flew in from overseas to get care at our medical center. Of course, they were able to afford it. But if you get really sick, the U.S. is a great place to get care. The U.S. has the most advanced medicine in the world — if you can access it.
Secondly, from a financial perspective the U.S. healthcare system is so complicated. I don’t know anyone who doesn’t work in healthcare who actually understands healthcare financing — how pricing is done and how interventions are paid for. And that’s just not right because we are all healthcare consumers — and that’s a problem we need to address.
The third problem I’ll highlight is that in the fee-for-service environment we’re still utilizing, the types of services we’re charging for has become a problem. We need to bundle services together. Over the last 50 years we’ve gotten really good at medicine — we’re able to treat a lot of conditions that we couldn’t treat not too long ago. But advanced medicine brings a lot of complexity. You need various specialists doing different things and giving multiple different drugs, coordinating both inpatient and outpatient care, including perhaps a surgical intervention, and other medical interventions all combined together. It’s gotten really complicated, and yet we’re still billing the same way we did 50 years ago when there were only a few things a physician could do.
Now, as we’ve added on those things we can do, a patient gets a bill with dozens or even hundreds of line items on it. That’s not consumer friendly. We need to bundle all this together. So, if you want to get a hip replacement there should be a charge for a hip replacement: one fee that covers everything — medicines, hospital stay, surgery, anesthesia — the whole episode of care. It’s good to see progress in this regard.
Not only would this simplify complicated billing for the consumer, but it would support innovation. As soon as you agree on the objectives and billing for interventions as one transaction, people start investigating how to create the best possible value. I think many physicians look around and realize that there’s a lot of waste in our system.
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.
The way I’d improve the healthcare system relates to the problems we just discussed. I’ll focus on three main ideas.
First, improving access: There are a lot of ways to do this. It doesn’t mean we have to get
get rid of the insurance system we have today or that we have to provide everyone with the exact same kind of insurance. It does mean we need to get everyone access to at least a basic level of medical care. It’s interesting that we’ve already legislated that in some distinct ways. As someone who was a hospitalist and spent ten years in the emergency department, I think it’s important to remind people that emergency physicians must take care of everybody regardless of their ability to pay. So, we’ve already legislated that you are guaranteed emergency care. You might not be able to visit your doctor the week before to prevent that emergency visit, but you can get emergency care. There are ways to provide basic services, which would not only improve care, it would probably cost less overall than what we spend today.
Second, the healthcare system has gotten so complex, not just financially but clinically too. It’s the physicians who are the main drivers of the healthcare system — in terms of what actually happens. You can’t get anything other than over-the-counter drugs without a physician. A physician has to order everything that costs money in the system in any significant way. These physicians are captaining complex processes, lots of different people, working in systems with other physicians. And yet, we only give them technical training. We teach them to understand physiology, pathology, and how to take care of people. We really don’t do very much to train them to be leaders within this complex system. We’re not training them to collaborate as organizational leaders. For example, when you speak with radiology technologists, they would all tell you the radiologist is a leader. The radiologists may not be their direct supervisor, but the radiologists is certainly a leader. Traditionally, we haven’t provided the training to our doctors to help them become the best possible leaders. That’s one reason why we are investing so much in professional development programs at Radiology Partners.
Third, get more doctors involved. We really need them to be doing more than taking care of patients. I think there is a huge difference between organizations that have physician leadership and those that don’t.
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?
The different topics I mentioned all have different concrete steps.
When you’re thinking about access to care, clearly there’s a huge public policy and governmental role. With that said, I believe individuals can have a big impact on what our government does. So, individuals supporting and advocating for solutions that could improve access is very important. Similarly, I think corporations and organizations must advocate as well. I think it’s also critically important corporations engage with policymakers — especially on complex healthcare policy.
We talked earlier about bundling of health care services and the innovation I believe it can drive. To me, this is where direct purchasers of healthcare — governments and businesses who buy healthcare coverage for their employees — can support change by using their purchase power to advance bundling and other innovative reimbursements. Certainly, the government has tried to do this with Center for Medicare and Medicaid Innovation (CMMI) policy. I hope we see this trend continue.
Finally, if you sincerely believe that physicians should be leading healthcare organizations, then we need to invest in their education and development. We do that as a private organization, but perhaps it should be integrated into medical school and residency training curricula.
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?
There are a lot of mental health issues that directly interplay with the “non-mental” aspects of healthcare. Physical health and mental health are clearly integrated within an individual patient, but they’re not very well integrated within the healthcare system.
For example, look at diabetes care. Mental health can have a big impact on how a patient and physician manage diabetes. Someone with mental health issues may require more active engagement to manage their diabetes appropriately. Additionally, uncontrolled diabetes may make managing their mental health issues more challenging. So, the conditions are intertwined clinically, but the system isn’t intertwined to manage them.
Some organizations that are doing more managed care — caring for the whole patient and assuming the responsibility for all the costs involved — have realized this. What I have seen work well is the ability to have a social worker or psychologist or psychiatrist available as part of the healthcare team taking care of that patient. And so, those providers aren’t siloed, making it the patient’s responsibility to get access. Instead, it’s a responsibility that internist is managing for the diabetic patient. So, at the same time they’re prescribing Metformin to manage the patient’s blood sugar, the doctor knows the patient has social issues that needs to be addressed, and they can access those services and specialists quickly without taking the patient to a separate care facility or imposing a separate charge. The internist is trying to manage the patient’s diabetes as much as they’re trying to manage the patient’s mental health issues. I’ve seen that prove effective and think it’s something that could go a long way. Mental health issues are not separate. It’s all in the same person, and it’s all tied together.
How would you define an “excellent healthcare provider”?
I think the Radiology Partners values help define excellence for healthcare providers. It’s certainly something that we’ve used here at RP, in terms of thinking about the effectiveness of our doctors. In fact, when our local practices evaluate a physician for potential partnership elevation they use the RP values — integrity, teamwork, excellence, service and accountability — which we know by the acronym ITESA. At RP, those qualities are all really important to be a great physician.
The value of excellence is probably the one that most applies to clinical performance — we want our doctors to always do the very best job that they can do clinically for their patients. When most of us think about healthcare providers, that aspect of clinical performance is what defines excellence. But there the other qualities that are important too. In radiology, it’s a service business. Being available to our customers is important, which in many cases is not the patient directly, but rather the referring physician. We need to ensure they get timely, accurate reports on imaging exams. We also need to be available to help them.
The teamwork aspect is really important as well. Healthcare works better as a team. Radiologists and other clinicians collaborate to come up with the best outcome for the patient. So, I really think the RP values do an awesome job of stating the qualities of a great healthcare provider.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
I love quotes. When I’m frustrated about the pace of innovation in healthcare, I’m reminded of this:
“Healthcare is the only industry where you can say the same thing for 10 years and still be seen as visionary,” -Jonathan Birch. Clearly, that’s not a leadership quote though.
Another quote I’ve used a lot applies to not only healthcare specifically, but in entrepreneurial, rapidly growing companies. RP is a rapidly growing organization — you can’t call us a start-up anymore. I’ve used this Mario Andretti quote with our people frequently, “If you have everything under control, you’re not moving fast enough.”
Anytime you are growing as quickly as RP is, everything isn’t going to work right. Things are changing too quickly. We’ve added so many new people. We’ve grown from two guys with some PowerPoint slides to 5,500 people in seven years. We’re adding new people to the team all the time. Every time the organization doubles in size, we need to change processes. The processes that served you when you were half the size don’t work anymore. New people, constant change — it’s not always going to work right all the time. There are some that say, ‘slow down,’ we don’t have control.’ I think the opposite. This is normal. We will solve it, we always do. And as we grow quickly, more things will break, and you fix those. If everything is totally under control and working smoothly, you’re not challenging yourself.
Are you working on any exciting new projects now? How do you think that will help people?
We have two efforts to implement artificial intelligence (AI) solutions within our practice that I’m very excited about. The myth about AI in radiology is that the computer will do the job of the radiologist. We don’t see that happening anytime in the foreseeable future. We see AI being used to augment our radiologists. Having our radiologists able to access technologies that support their abilities to do a better job.
The first of these efforts will make it easier for radiologists to identify some of the more easy-to-miss findings. This will both improve patient care, because we’re going to see some things that maybe would not have been noticed before, which is great. But it’s also going to support our radiologists in terms of helping them become more productive — because it will help give them comfort to confirm what they are seeing, which is a really good thing.
The second AI tool will help our radiologists in terms of getting that report done in a more consistent rate, which is something that our referring physicians always are looking for. Referring physicians want a clear, concise, organized report that is done the same way every time. So, we have an AI project that will help our radiologists get those reports done that way.
We are a locally-led practice; no one forces our radiologists to do certain things, like use AI technology. But we do want to make such tools available to help them. That is a benefit of our scale; our radiologists have access to tools to help them be more efficient and more effective. One of our radiologist leaders likes to say, “it’s not that we have better radiologists”, (although maybe we do), “it’s that we have tools that allow them to practice at a higher level.”
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
I read a lot of books on leadership and development. But, the one that I probably come back to and re-read the most is Seven Habits of Highly Effective People by Stephen Covey. I’ve read it ten times. It’s a book I probably read every year or two. Now I listen to it since I’m a big audio book guy.
I am also a big fan of Tim Ferris’ podcast, Tribe of Mentors. I love the questions he asks. I’m often reminded of the quote, “A question well asked is half answered.” And Tim comes up with those kinds of questions. He comes up with questions that are insightful and provoke interesting responses from people. I’ve probably modified my interview technique, in part, by listening to him interview people on his show.
It’s amazing what you can learn about being a healthcare leader by understanding the tremendous things someone has done as a celebrity, an athlete or a military general. Vocations that at first you would say, “That’s totally different from what I do.” But, these highly accomplished people in other walks of life offer a lot of lessons that carry over to healthcare leadership and I’ve found it to be very helpful.
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? You never know what your idea can trigger. 🙂
I’ve always had a passion for learning — both for myself, as well as, enabling other people to be able to take advantage of being able to learn. What would drive the most good for the most people across the world would be to enable learning opportunities.
To make that reality global, I think there are two things that have to happen. First, unfortunately, there are a whole lot of people who aren’t literate. So, part one, for me, would be teaching everyone throughout the world to read and write. I’m pretty sure there’s an X PRIZE out there to do exactly that: create a device for under 100 dollar that could teach everyone to read or write on their own.
The second would be worldwide internet access. Both of my daughters, who are in college right now, tell me that Khan Academy is better than their professors. Certainly, when they were in high school, they said that. So, if you want to learn about anything, you can just get online and learn about all kinds of things. Or you can go to different places and learn about whether you want to be an engineer or how to farm or wherever you want to learn. All this information is out there, so enabling massive worldwide internet access combined with literacy would just drive so much good for the world.