Make healthcare affordable for everyone. The Affordable Care Act enabled significant improvements in insurance coverage, but we still have too many people who are either uninsured or underinsured. Healthcare should not lead to personal bankruptcy. We have the power to make high-quality care the standard using technology, which in turn can help minimize waste, improve health outcomes and ultimately lower costs for patients and providers.
The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement.
In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System.
As a part of this series, I had the pleasure to interview Dr. Denise Basow.
Denise Basow, MD, is President and CEO of Clinical Effectiveness at Wolters Kluwer, Health, where she focuses on fulfilling her organization’s mission to reduce unwanted variability in care and measurably improve clinical effectiveness. Board-certified in Internal Medicine, Dr. Basow has over thirty years of clinical and business experience leading high-performing teams and driving growth. She earned a Bachelor of Arts in chemistry from Duke University, attended Baylor College of Medicine and completed her internal medicine residency at Johns Hopkins.
Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a bit about your backstory and a bit about what brought you to this specific career path?
I had been practicing primary care for about four years when I serendipitously met the founder of a start-up company called UpToDate. I immediately related to its mission. UpToDate was solving a problem that I found very challenging in my own practice. During my training, I had access to the best physicians in nearly every specialty to consult with and answer questions. But once I left training, that support system was gone, yet patients were walking into my office several times a day with complicated problems and questions, and I lacked easy access to answers. The vision of UpToDate was to quickly answer those questions using the best evidence available so every physician, regardless of their location, could provide the best healthcare to their patients. Fortunately, that vision has since come true. I’m proud to say that today we support over 2 million clinicians worldwide. We are answering more than 1,200 physician questions per minute which has proven to improve health outcomes on a massive scale.
I joined UpToDate as an editor in 1996, and unexpectedly found myself running the business once it was acquired by Wolters Kluwer in 2008. I feel fortunate that I met UpToDate founder, Dr. Bud Rose, at a time when he needed people like me to help build the business. Though I did not go to medical school to be a businessperson, the impact my team and I are having by working every day to ensure the best care everywhere has exceeded all expectations I had for my career.
Can you share the most interesting story that happened to you since you began your career?
Over the course of my career, I’ve had the privilege of meeting some of the greatest minds in medicine, traveling to dozens of countries, and observing firsthand how patient care is delivered around the world. One particularly interesting story was a meeting I had with the ministry of health in a country I won’t mention. It was a very formal meeting with about a dozen people, and I was the only woman. We talked about the specifics of a business deal, after which one of the men asked that I take the proposal back to someone in the organization who could make the final decision. At that point, to his great surprise, I informed him that I had good news, as I was the decisionmaker with the authority to ink the deal. That was a moment of my career that I reflect on often, particularly as women continue to face inequality in the workplace. Though at Wolters Kluwer we are proud that 50% of division CEOs and managing directors are women.
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?
I have made a lot of mistakes over the years, and while I’m not sure too many of them are funny, there are a few I can look back on and laugh at now. The mistakes I have learned the most from share the common theme of miscommunication. Sometimes we call our business the biggest game of telephone ever played (you know, the game where you whisper something to one person, they whisper to the next, and so on, until the last person reveals what they heard, which usually barely resembles what was initially spoken). We unintentionally play that game almost every day, which can be comical on occasion, but also highlights how critical it is to be as clear as possible in communicating, and to never take that clarity for granted. You need to check in often to see how clear you were, and the number of times you need to check-in tends to be proportional to the importance of what you are trying to communicate. I’ve learned that effective communication is one of the most critical parts of leadership.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
My favorite quote is from Walt Whitman: “Be curious, not judgmental.” I like it because it suggests we shouldn’t make assumptions about people, but rather listen more carefully to really understand them. At least once a week, someone will tell me how they were in a conversation at work and the person they were talking to was not making any sense. I tend to find it hard to believe because I’ve learned that almost everyone thinks rationally, they may just be working from a different set of facts or have a different perspective on the facts. It’s worth spending the time to ask the right questions and listen to them; from my experience, I can say that you’re likely to learn something from that process that changes your own perspective.
Are you working on any exciting new projects now? How do you think that will help people?
Wolters Kluwer is a mission-driven business and everything we do is aimed at removing barriers that get in the way of providing the best healthcare everywhere. To support that mission, we have several projects underway, ranging from improving the virtual care experience, given how remote care exploded during COVID, to engaging patients through journeys of care for chronic health conditions, to reducing medication errors in countries outside the U.S. We believe wholeheartedly that this work will demonstrably improve access to care, reduce inequities and help address the many determinants of healthcare quality.
How would you define an “excellent healthcare provider”?
That is a simple question without a straightforward answer, as the definition may change depending on the situation. If I need emergency surgery for example, the only thing I care about in that moment is the surgical skill of the doctor performing the procedure. If we set aside those special situations though, I think the most effective healthcare providers display excellent communication skills, empathy, and are both knowledgeable and thorough. We’re also likely to see this definition evolve and expand as more care is delivered outside the four walls of a hospital or clinic and in virtual formats.
Ok, thank you for that. Let’s now jump to the main focus of our interview. The COVID-19 pandemic has put intense pressure on the American healthcare system. Some healthcare systems were at a complete loss as to how to handle this crisis. Can you share with our readers a few examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these specific issues moving forward?
The biggest challenges America faced with COVID-19 unequivocally fall into the category of public health. As a country, we did not have adequate supplies such as personal protective equipment (PPE), nor did we have a coordinated way to acquire and distribute that equipment. We didn’t get on top of testing fast enough, and we didn’t move quickly enough on measures like masks, quarantines and travel restrictions that could have impacted the pandemic early. The countries that did best had prior recent experience with public health emergencies and moved faster and more effectively in these areas.
I believe we have learned our lesson in the U.S. and are better prepared to avoid this level of devastation in the future. Moving forward, we need to make the proper investments in public health, so we’re equipped when it’s time to act.
Of course the story was not entirely negative. Healthcare professionals were true heroes on the front lines of the crisis. The COVID vaccines are saving millions of lives. Can you share a few ways that our healthcare system really did well? If you can, please share a story or example.
I’m so glad you asked this question and want to emphasize that the term hero is not hyperbole. Nurses bore the brunt of the pandemic and literally gave their lives to save others. I also want to call out the many physicians and other healthcare professionals who flocked to New York when the city became the epicenter of cases and deaths in the U.S. early on and was desperate for help.
And since you mention vaccines, I believe the vaccine response to the pandemic will ultimately be recognized as one of the critical developments and turning points in our public health history. The scientists who toiled for years and years to lay the groundwork allowed the rapid development, testing, and production of vaccines that are saving thousands of lives and are giving us the chance to move on to a post-pandemic life. It is a remarkable feat of science and industry.
Here is the primary question of our discussion. As a healthcare leader 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.
1. Improve how patient data is shared across healthcare settings and platforms (interoperability). Despite spending more than 15B dollars annually on electronic health records (EHRs), we are still in a situation where we can’t adequately share data between information systems, and this significantly limits our ability to take advantage of that data. It’s still not easy to get medical records when traveling from one healthcare system to another unless they happen to use the same EHR. Further, as we begin to see the importance of real-world evidence, where we can potentially use patient data from multiple sources to enhance our evidence base, broader data sharing could significantly improve our knowledge of healthcare outcomes and effective diagnostic and treatment pathways.
2. Make healthcare affordable for everyone. The Affordable Care Act enabled significant improvements in insurance coverage, but we still have too many people who are either uninsured or underinsured. Healthcare should not lead to personal bankruptcy. We have the power to make high-quality care the standard using technology, which in turn can help minimize waste, improve health outcomes and ultimately lower costs for patients and providers.
3. Empower patients to be part of the care team. Patients are the most underutilized resource in healthcare. We know that when patients are educated, engaged, and properly motivated, they can make better decisions, avoid unnecessary procedures, and have better health outcomes.
4. Promote evidence-based care everywhere. We need to eliminate the healthcare zip code lottery. Patients shouldn’t receive different care for no other reason than where they live. Yet there is very good data to show that patients only receive about half the recommended care. Some of this is because there is too much new medical information for clinicians to absorb, and some of it is because that information isn’t being accessed when meeting with patients at the point of care. Either way, this is a solvable problem that isn’t often discussed, and yet it contributes to high cost and poor-quality care.
5. Target chronic conditions. 45% of Americans have at least one chronic disease, and more than half of older adults have more than three. 90% of every healthcare dollar goes to treating people with chronic conditions and 47% of the total cost of chronic disease is related to obesity. The burden of chronic diseases continues to rise, especially as the population ages. This is an impending disaster for the solvency of our healthcare system and one that needs to be addressed faster and more effectively right now. Fortunately, there is good work being done to address the management of chronic conditions in new ways, such as remote care monitoring with familiar devices like mobile phones and smart speakers, that can help keep patients on track and out of the hospital.
Let’s zoom in on this a bit deeper. How do you think we can address the problem of physician shortages?
A recent survey from the Association of American Medical Colleges (AAMC) projects a shortfall of 37,800 to 124,000 physicians by 2034. This is due to the combination of an aging population, aging physicians, and possibly increasing physician burnout, which was already high prior to COVID-19 but now is even higher. I believe clinicians in other roles like Advanced Practice Registered Nurses (APRNs) and Physician Assistants (PAs) will be instrumental in meeting some of the growing demand, as diversifying the clinical workforce can help reduce some of the geographical supply and demand issues. Additionally, some level of regulation will likely be needed. Fortunately, there is a new bill being considered right now to increase the number of residency positions in the U.S. (the Resident Physician Shortage Reduction Act of 2021).
How do you think we can address the issue of physician diversity?
Medical training is a long and arduous journey that requires a lengthy period of both financial and emotional support, as well as a lot of preparation. Medical schools are trying to address diversity in their admissions process, but to really make progress, efforts need to begin much earlier to identify diverse candidates in the college years or even pre-college years. Reducing the cost of medical school or providing more financial support is also critical, and we could even think of more novel ideas like paying medical students prior to residency training. We can also make it easier for prospective medical students to access programs like the National Health Services Corps (NHSC) loan forgiveness in exchange for serving in areas where there is a high need for health professionals.
How do you think we can address the issue of physician burnout?
One of the most impactful ways to address physician burnout is to make a concerted effort to get doctors away from the computer. We all know the headlines: doctors are spending less and less time on patient care and more and more time documenting in the EHR. One study published last year found that for every patient they see, doctors spend about 16 minutes using the EHR. We need to make the process of documenting clinical encounters easier and to show more value-add for the time spent. It would also help to make permanent some things that were adopted during the public health emergency, like flexibility and reimbursement for virtual care.
What concrete steps would have to be done to actually manifest all of the changes you mentioned? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
To achieve what has been discussed, we need to leverage technology to do what it was designed for, so doctors can focus on the things that they are trained for and good at — delivering high quality, empathetic patient care. From a corporate standpoint, EHR companies need to play better with industry (this may require legislation) to facilitate innovation that can improve the efficiency of the patient encounter and the quality of care delivered. We also need to broaden and coordinate our efforts to engage patients in their own care. If we want to stave off the impending disaster of an older population with multiple chronic conditions, we cannot do it with healthcare providers alone. We must use all assets at our disposal, including technology to assist with patient communication, or we won’t be successful.
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. 🙂
In the short term, I would focus on getting everyone in the world vaccinated against COVID-19. For the longer term, I would wage a coordinated battle against the obesity epidemic. It would require better access to healthy food and careful consideration of poverty and other social determinants of health, as well as broader access to healthcare services and education, among many other things. But if you think about how much disease is related to obesity, we could make the world a much better, healthier place by focusing more on it.
How can our readers further follow your work online?
I encourage anyone interested in following the work at Wolters Kluwer to visit our website where you can find expert insights and our latest news. Visit https://www.wolterskluwer.com/en/health.
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.