We must take a holistic view of health. We need to care for the entire person — their physical, mental, emotional, and financial health — taking into account all the factors (present or absent) that play a role in their health and wellbeing.
As a part of our interview series called “5 Things We Must Do To Improve the US Healthcare System”, I had the pleasure to interview John Distefano.
John is head of Nordic’s Advisory Services, where he leads a practice dedicated to bringing transformational solutions to clients’ most pressing issues across clinical, operational and health IT domains. For more than 30 years, John has been catalyzing innovation with payers, providers and government clients, helping senior executives align their business strategies to the challenges and opportunities presented by a transforming health care environment. Prior to joining Nordic, John was a consultant at Accenture and Ernst and Young, where he was recognized by Consultant Magazine as one of the nation’s top 25 consultants for his achievements in healthcare.
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 story about what brought you to this specific career path?
Like everyone, I have plenty of stories of loved ones interacting with the health system; in some cases those experiences were less than optimal. That prompted me, as a kid recently out of college with a degree in Computer Science, to join what was the largest Health IT firm at the time (McDonnel Douglas Health Systems). I had the intention of working full time and studying for a Masters in Information Technology (which did happen thanks to an understanding wife, a flexible employer and committed instructors!).
Right away, however, I saw real opportunities to make meaningful change in health delivery using technology. Before there were EMR/EHRs, there were clinical information systems. I thought that helping provider systems to implement and use those technologies would be a fast way to solve the gaps in care and other problems presented by paper and pen records.
I discovered that I had a passion for bringing tech to the forefront of care (and that there were no quick fixes). That has stayed with me even today; while we’ve made huge gains, there is still much that can be done to improve the quality and cost efficiency of health care using tech.
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?
At the time, technology use in health was still very new and not very widespread. That made me think (and in retrospect this was a bit naïve) that clinicians weren’t going to be tech savvy. I discovered very early on how wrong I was. In fact, the person that taught me the most about the application of tech to the delivery of care was a nurse at a University Medical Center.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
There are two that pop up just about daily.
Early in my career, I was meeting with a client who wanted a redesign of a global IT network and switching system. This was a bigger project than I had managed up to that point in time. As always, I approached the conversation openly and let him know that while I was an expert in my domain, I wasn’t well versed in the ins and out of network technology. He replied, “As long as you always use your best judgement in my best interest, we’ll be just fine.” No day goes by where I don’t think about that — it became a maxim that has guided my professional life.
The second is about getting the right balance in life. My wife and I recently celebrated our 40th wedding anniversary. Very early on I began making a list of my work priorities and personal commitments so that I had a clear view of all my obligations. But the real best practice has always been to take that list to my wife and ask her what order to do them in.
How would you define an “excellent healthcare provider”?
Someone who treats the whole person, not a patient with a particular condition. An excellent clinician is one who can take an evidence-based approach to treating the person’s condition, but who understands that the person comes with a set of experiences, fears, goals, motivations and more that makes them unique.
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 once went to a 3-day leadership retreat where many of the sessions took place on the battlefields of Gettysburg. The goal was to understand the leaders’ mindset, where they were and what they were trying to accomplish, and to overlay that against the events of that day. From that I learned that leadership is about seeing beyond your team. It’s important to understand the strategic intent of the mission, and to execute towards that intent. I also took away the idea that innovation and success start with careful attention to the small details.
Are you working on any exciting new projects now? How do you think that will help people?
I feel very fortunate that the Board of Directors and leadership team at Nordic are allowing me and our team the opportunity to chase some inspirational and game-changing solutions. We are always looking for ways to provide clinical care teams with timely information supported by the right amount of context, and the kinds of tools that improve their interaction with, and delivery of care for, the people they look after. The flip side of that is giving people similarly useful information and tools so that they can take charge of their health journey. Ultimately, we want to improve the clinical workflow and patient experience in a way that meets the needs of all the stakeholders in the health ecosystem.
Ok, thank you for that. Let’s now jump to the main focus of our interview. 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?
The U.S. healthcare system isn’t the disaster that it’s made out to be. We’ve made choices about what types of care to prioritize: we have created centers of excellence. Our health system is fantastic at treating certain kinds of complex conditions — and making incremental innovations in those treatments. Cancer screening in the U.S., for instance, is among the best in the world and we are near the top for cancer treatment as well.
Plotting our life expectancy against our spend makes it obvious that we need to put some thought into how we are allocating our limited health resources. In a more recent report, the Commonwealth Fund points to some of the areas where could improve — our rates of chronic disease are dangerously high; obesity rates, at 40%, are well above the OECD average (21%); the heartbreaking numbers of suicides highlight the dearth of mental health services; and access to care remains a huge problem (we have fewest physicians per capita in the developed world).
We are not currently putting enough resources towards being a health and well-being society. Diets, nutrition, and food priorities aren’t driven by health concerns. We aren’t creating an environment that promotes health and activity. Addressing our current shortfalls means more of an emphasis on encouraging health and wellbeing instead of waiting until someone is sick enough to require treatment.
As 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.
- We must take a holistic view of health. We need to care for the entire person — their physical, mental, emotional, and financial health — taking into account all the factors (present or absent) that play a role in their health and wellbeing.
- We need better coordination along the care continuum. Our health system has become highly specialized, but there are huge gaps between those points of excellent care. And by becoming highly specialized, we lack the emphasis on everyday care.
- Keeping people well. Primary care and family medicine docs can be the health quarterback. Right now they get paid to do a bit of preventive care, but mostly to get you to the right specialist when you are ill. We need to flip that script and empower them with the tools to manage health.
- Better payer/provider alignment and a more rapid shift to value-based care. There is still too much reimbursement for procedural and episodic care. The revenue drop that most health systems experienced during the height of the COVID-19 pandemic is a great example of how reliant we are on discretionary procedures. Aligning incentives in a way that feels fair to all stakeholders is vital to changing our focus on, and delivery of, “healthy” care.
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?
People can be empowered with tools to manage their health throughout their life. That includes a clearer understanding of how individual actions have cumulative effects on health. We can also create better incentives for doing the right thing.
Healthcare providers and health payers, working through reimbursement agreements that prioritize outcomes over procedures, will have an enormously positive impact on the way the entire system thinks about health (and its preservation) and the way care is delivered.
Political leaders can continue to reward innovation and use government health programs (like Medicaid and Medicare) to accelerate the shift to value-based care.
The COVID-19 pandemic has put intense pressure on the American healthcare system, leaving some hospital systems at a complete loss as to how to handle this crisis. Can you share with us examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these issues moving forward?
COVID-19 really laid bare one of the health system’s big vulnerabilities. We have a fantastic infrastructure designed to deal incredibly well with very specific illnesses, but revenues are largely driven by discretionary procedures. When operating theaters shut down, revenue disappeared.
We have the opportunity to reevaluate how we deliver care, focusing on getting people to the right care, at the right time, in the right setting. Building more of the infrastructure that supports people as they move along the continuum of care, ensuring continuity between the episodes of excellence, is a key part of that.
We also need to invest more on the prevention side, and technology has a big role to play. Technology can be a lever that allows small groups of people to do the kinds of population health management that keeps people well. It can augment the human interaction we all want when we are ill, and give people the tools to think and make decisions about their health in real-time, in real world settings.
We have to choose how to invest — are we going to allocate the most money to making incremental changes to the kinds of care at which we already excel? Or are we going to spend it on the technology and data that already exist, putting it to work at creating better health outcomes?
How do you think we can address the problem of physician shortages?
Making them feel valued again. Most physicians are willing to spend the incredibly hard years of learning and training to gain the opportunity to treat and elevate the health and wellbeing of the people in the communities in which they live. What we give them today are years of long hours, pay levels under scrutiny, and a focus on doing tasks that will pay the loans, the liability and malpractice insurance, etc., and, at best, some help “managing” burnout. Why aren’t we enabling them to do the things they went to school for — caring for people?
How do you think we can address the issue of physician diversity?
Being a physician is a privileged and valued role in society, but we require them to be perfect and are liable for it financially and morally if they expose the fact that they too are human. Medical school is expensive, the hours are incredibly long, and it is years before the average physician gets a paycheck that does more than cover basic expenses (including loans). These are barriers that some cannot cross, and puts strain on those looking to start a family before their mid-thirties.
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 is much that can be done to make mental health an integral part of healthcare; treatment is so disjointed now. Part of the equation is more primary care, and to change to reimbursement structures to make that kind of care possible. It also requires more mental health professionals and more resources directed to the community.
There is also a technology component. Newer sensors and wearables can be used to provide data that incorporate more of the social determinants of health, and that help us get better at predicting when someone might be at increased risk of mental health issues due to new life events. We want to recognize the difficulties someone is facing before an acute episode or need for a diagnosis.
Tech can also be a lever to do more frequent touchpoints or provide better self-care. There are apps and chatbots that already serve as an in-between mental health management tool, and the pandemic showed us just how powerful virtual health can be, with the potential to improve access and help people stay connected.
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 want to give people more control — help them be informed, engaged, accountable and empowered to manage their health. Part of that is trying to put better infrastructure in place to better stitch together the pockets of excellence in care delivery, and part of it is a combination of the right insights and tools for change.
How can our readers further follow your work online?
I, and the other leaders at Nordic, share out thoughts on our website fairly regularly.
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.