The Future of Healthcare | Joseph Deluca

 

About Joe DeLuca

Joe has 30+ years of management, research, and advisory experience in health care, with a focus on enterprise performance management and affecting change through IT strategy and services. As Managing Practice Director, Joe provides advisory, project management, and leadership development services to health systems, hospitals, academic medical centers and independent physician associations. Known for his ability to transform high-level business objectives into successful, executable business strategies, Joe is on the forefront of new generation business to technology alignment, working with organizations that have emerged as today’s technology development and adoption leaders. Mr. DeLuca frequently educates, speaks and publishes on the future of health care technologies. He is a Fellow of the American College of Healthcare Executives (FACHE) and has served on the board of numerous for-profit and non-profit organizations. He holds a Bachelor of Arts degree in Biology from Lawrence University and a Master of Arts degree in Health Services Administration from the University of Wisconsin, Madison. Joe founded IT Optimizers in 1998 after successfully negotiating the sale of his former firm to a large defense contractor. As the CEO and managing practice director, Joe oversees internal strategy, planning and operations. On the client side, Joe’s domain expertise includes complex, multi-organizational initiatives and high risk projects.

 

Transcript:

Alan
Welcome back. I’m here today with Joe DeLuca. He is the founder of it. optimizers. Joe, welcome to today’s show.

Joseph
Thank you and pleasure to be here.

Alan
So Joe, can you give us the background? How did you get where you are today and the experiences you had along the way?

Joseph
Sure. Well, first did it optimizers. We are a healthcare specific informatics and information technology consulting firm. And it’s really at the sort of pinnacle of my career, I started back. I won’t date myself completely. But it started back in the college days where I was a scientist doing early stage DNA research and looking towards the possibility of a MD or PhD type career, and decided instead to aggressively move into healthcare program management, where I started to use informatics and data processing, if you will, data analytics to improve the quality and efficiency and effectiveness of our healthcare system. I was fortunate enough to work in some early leading projects that gave me the taste allowed me to see some of the success, the shows associated with that. And that’s continued on to a career in consulting at the high end of Healthcare Informatics.

Alan
This has been a big part of healthcare advancements in recent years with, I believe one of the early pioneers, correct me if I’m wrong, but at the metrics, were they early in this stage, and then, you know, for health DNA mapping.

Joseph
They were so so they were early for that developed microfluidic technologies, which allowed for the rapid and decreasingly expensive DNA analysis was very expensive, at first and required large high end machinery data processing tools to achieve that. And the the processes to do that on a very cost effective almost on a chip basis, is one of the things that they pioneered and continues on today, to where we can now start to envision that you can have your entire personal genome mapped for under a few $1,000, which before would have would have cost 10s to hundreds of 1000s of dollars. And the long term effect of that, of course, is that then we could take and individualize your treatment protocols for you specifically, especially in areas such as cancer treatment. There’s a lot of work in breast in prostate cancer in particular, where you can now take diagnose what the specific genome of the cancer is, and attack that on an individualized basis, just to some small examples of that.

Alan
Now this in in IP optimizers, who is your typical client who’s coming to you?

Joseph
So our our typical client is a large 234 hospital based health system, which would also have some health plan operations, large physician practices associated with it. So someone who is trying to achieve or has already achieved what we would call a healthcare delivery system, where they’ve been able to focus, hospital physician, continuing care and payment together in some way. Not quite at the Kaiser level, Kaiser tends to be the embodiment of both but their market, if you believe the advertisement to be care and financing together a bit organizations who who are trying to get there to basically manage a population of of their residents around them. So we have many of those in the Bay Area, as well as across the country who are doing but that’s our primary, then we also serve the health plan industry. So roughly a third of our of our clients would be health plans or a delegated risk physician group. So that’s a physicians group of scale who has for an economic price $1 per member per month, taking on responsibility to manage the care of their patients, both on the outpatient basis as well as on the inpatient basis. A good example of that would be for example, Hill physicians Medical Group,

Alan
You know, the the Affordable Health Care Act must have had some impact on what you do.

Joseph
We have it’s created a first a great land grab for physicians and for provider networks. You know, it has also created in interesting ways, very unintended, positive and negative consequences. So some of the positive consequences are there’s been a tremendous reshift to what is healthcare really about? So historically, it’s been about fixing that broken way, making sure that you’re reasonably healthy, but really about correcting illness or trying to remediate an illness, so the Affordable Care Act with an emphasis on population medicine has really started to focus on how do we create health. And it’s a long term discussion. It doesn’t happen overnight. But it’s been a very good conversation to have. It’s somewhat always been in the healthcare system. But we’ve never had a mandate to really look at it. The other real positive side of the Affordable Care Act, of course, has been New Industries Building up in particular around consumer based care virtual based care models. And those are in part driven, because has, through the Affordable Care Act, we’re getting more insured patients in, we don’t have the physician or caregiver workforce to really meet that demand. Plus, there is a growing cap on the amount of reimbursement that we’re going to have in our system. So we have to look at alternative means to providing care. By saying the alternative, that doesn’t necessarily mean worse, I think some of the models are showing that the alternative care models are equal to or better than the traditional medicine side. And then of course, there’s some bad sides to it. And we just got our premium increases we had in our company, we had to go to an ACA compliant plan. And costs are going up. And some insurers are starting to look at leaving the market for for the ACA compliant plans, if you will, or for providing the individual coverage, because of the of the costs associated with it.

Alan
And a lot of people are in this, the renewal period and experience right now. Right, the the bump and premium. So I visit here today with Joe DeLuca. He is the founder of it optimizers show nice, it’s a quick break, we’ll be right back after these messages.

Alan
Since you can’t take your wealth with you spend time with your family.

Alan
Welcome back, I’m here today with Joseph DeLuca. He is the founder of IP optimizers. And we’ve been talking about transformation of the healthcare industry. And one of the things I’ve noticed is it, there’s somewhat of a disconnect, it seems that, you know, the industry is trying to move over more to wellness rather than treating symptoms and disconnects. And what do you see this right now.

Joseph
So that that is absolutely one of the directions and for lack of a better word, both the policy mandate and quite frankly, what most people want is to maintain your health rather than having to deal with illness. We has a an industry, if you will. And as a country, we’ve we’ve always had a focus on wellness and health. But we’ve not had an economic model to support that. So even today, in large parts of our health care system, a physician is paid on a fee for service basis, because you have an office visit or you go in for a procedure rather than on maintaining your health, where then they receive a certain amount of dollars per month to do all of the services for you over a long period of time. So that they can give you more expensive tests upfront, but it might prevent or or do an early diagnosis of a of a problem. So part of for example, we were talking earlier about the Affordable Care Act, some of the good parts about that are mandating immunizations as part of routine coverage, mandating certain levels of required diagnostic tests upfront, which are proven to have long term benefits by reducing either catching things early or preventing illnesses. But we still are working in a NIC system. So the concept of health and wellness is inconsistent with large parts of the economic model, even though we think it’s it’s the good thing to do from from a humanistic and moral perspective. But we’re getting there. There’s some some good changes that are coming about but it will take time.

Alan
Now informatics is a software based company.

Joseph
So informatics is sort of a broad term that we use to to relate to the management and interpretation of data in the healthcare system and informatics doesn’t necessarily have to be related to healthcare, per se, but we really use it to basically reflect the collection and transference transformation of data into meaningful With information sort of like the science of how we do that, and it could be as simple as, how do we do a better predictive diagnosis of someone who’s having a heart attack? Or it could be how do we find out a better way use these large databases to find a better way to treat and manage diabetics? Or it could be, in the case of community based medicine, how do we find the people in the community who are calling 911 using 911, inappropriately from a system perspective, and intervene with them, our EMS system is great as identifying who are the patients who run out of money at certain points of the month. So they don’t take the required food with their potential medications, they then have some form of an adverse drug reaction and their responses, especially in the elderly population, to call 911. So informatics would help to identify those hotspots of need, and then to get community based social services involved as an example, to help that. So it’s a very broad use of the term but it’s really about data analytics, transforming that into information for a positive outcome. Talked about these are some clinical examples. But there are also others that would relate to reducing costs, reducing variation in care, getting clinicians to work at at a different level in the system. So having a nurse, for example, do things that a physician might otherwise do. So it’s within the scope of their license, but helped to extend this the range of their productivity. And we can prove that using data that, for example, having the nurse involved or having the nurse do it doesn’t affect the quality of care might even improve the quality of character versus a physician.

Alan
And visiting here today with Joe DeLuca, he is the founder of it optimizers. And we’ve been talking about the future of healthcare, so I need to take a quick break. We’ll be right back after this.

Alan
Welcome back and visiting here today with Joe DeLuca. We’ve been talking about the programs that you have running at it optimizers, which is focusing on I’m going to just call it Big Data analytics for the healthcare industry. But it’s, you know, what fascinates me is from a consumer standpoint, you know, we look at our the Affordable Care Act, and what that did to private insurance premiums, and overall, but but you’re working on a entirely different platform of trying to revolutionize and change an industry that has been based on reactive medicine to preventive medicine. Now, how do you incentivize companies and healthcare organizations to go along with with this change?

Joseph
That’s sort of the $64,000 question about how you do it and actually achieve it. And I think there’s there’s different groups that have to be incentivized and motivated, you know, there’s courts, the the traditional health care provider, system, hospitals, doctors. And largely, they’re going to get incentivized by seeing at least equal economic neutrality to where they’re at in a fee for service market to sort of polarize the decision question between fee for service and health and wellness being being in a different economic model than that. So they have to see that they will at least be no worse off by doing this economically and potentially better off. So the Affordable Care Act and other other programs that were in place before ACA came in primarily in Medicare. In the state of California medical, we’re focused on providing value based payment incentives. So we will pay you what you were getting before. And if you deliver better quality, you reduce admissions to hospitals for cases that you’ve already had there. So basically, you treat them right the first time. We’ll give you more money for doing this. So that helps to raise the economic bubble and provide some motivation that way. But really what’s happening from a motivational perspective depends on on the age cohort of individuals so we look at younger, younger arsons, millennials in particular, they’re completely motivated differently relative to health and the use of the healthcare system. So a lot of their economic motivation will basically come from alternative therapies. Viewing the healthcare system has the place of last resort, I go to the hospital or the doctor, when I’m really, really sick. I go to my alternative panels, and of metal medical providers, possibly those that are actually within my employer environment, Google Apple, others have been very good at setting up alternative therapy clinics within their employee environment. And their their motivation is really to reduce costs for them, they don’t want to expend the money that we’re having to pay in, in our age cohorts. So at the end of the day, it’s really going to still come down to the money to the money side, and how we at least on one side, keep neutral and provide some, some room for growth. And on the other side, keep healthcare costs low, because at the millennium and mid career level, that’s disposable income, that’s going out, the more I have to pay for health care, the more less money I have for other lifestyle needs. There’ll be a family, so forth.

Alan
In the in the news recently, you saw companies like Theranos, who is on all about wellness. So Walgreens pulled the plug and said, you know, okay, we’re going to kind of live it, you know, how does that affect the industry as a whole? And what’s your take on that.

Joseph
So that’s a good one. There’s a lot of different dimensions of because we look at that, that companies primarily primary disruptive strategy, which is to take this Goliath lab testing industry, and break it down to miniaturization that can be done at point of care. If they are effective at doing that, that’s not only a consumer based approach, but you take that same technology and put it into the hospital setting, and allow at the bedside, the complexity of testing of blood based testing that you would otherwise have to ship that blood off run a centralized lab to do huge disruption and to the system and the potential huge reduction in costs. So, so very noble effort, very, very important area to work on. On the other hand, though, the company has really been cloaked in secrecy. And in the healthcare industry, we don’t like the lack of transparency. So they create suspicions about what what is behind the product or not behind the product, and also creates a sort of an attitude that while they’re doing this now, what are they going to do in the future? What’s the real motive behind this? So we’ve been fighting it, you know, with whether it’s medical device companies, pharmaceutical companies, big medicine, the payers, that healthcare insurance companies sort of fight through the same item, we’re now looking at very, very strong quality transparency measures. So when we look, go back to the informatics side, a lot of what we end up having to do is public based quality reporting. So you can now go out to public websites, and you can compare your doctor your hospital against different quality measures against life statistics, you know, if I go there with a heart attack, not only what is my likelihood of surviving there, but what will my quality of life be like afterwards, so, so we’re moving more and more towards broader base transparency. And at least in particular, that company embodied less of that at a time when we’re sea change, when we’re seeking more of that.

Alan
I’m going to kind of change the direction I want to I want to talk about it optimized, one of the things that you do is you help companies with strategic planning and also building effective teams to manage change. How do you build the effective team within these larger organizations?

Joseph
So it’s, it’s a very multifaceted questions. So to build the teams, we first have to identify what the performance excellence goal is that we’re trying to achieve within the organization. And then take a look at Do we have leadership within the organization that we can take and transform? Or do we in our transformation effort basically have to recognize we need a new generation of leadership around that. And then we tend to put a lot of fancy words around it, but it’s really pretty simple human management and professional development dynamics that you come in, find out what the goal is you develop the goals, put together usually a multi year plan about how we’re going to get there and then start working for small, small kernels of success, that start to build the management competencies and the confidence in what they’re doing. It’s all about competence, just like a sports team, you know, the best talent but you’ve got to build them up. So we find those kernels and then just start building it up. You’ll inevitably have Couple setbacks, those are actually good. Because you can then use that as a way of refocusing the team and getting them up to a level of performance excellence that then embodies their competence to move forward. Sadly, at times, it means that you have to recognize you have the wrong people on the bus, you have to get some new people on the bus. So when that occurs, you know, it’s helpful that you can move, move people around in a in a very professional way, or the ones I love or when it’s denoble, which is brand new functions were standing up, in which case we can really grow a new team. We had one of the highest compliments paid to us recently at a client site where they said you built this function. And while you thought you were just standing up this particular business unit for us this analytics unit, it really raised the bar performance across the organization, because everyone started looking at what you were doing. And then all of our clinical management teams or financial management teams, said, We need to be more like that. So we became a team to emulate in the processes quite a compliment. Really enjoyed that one.

Alan
So a person that’s interested in engaging it optimizers how would they go about contacting you?

Joseph
Hit a website, give me a call, or hit my email on the website? It optimizers.com it optimizers.com based in Oakland, California. Joe, I

Alan
appreciate you having it today.

Joseph
Thank you, it’s a good time to do so how many years? Have we worked together? No, no, we’ve

Alan
been together for over 25 years. And so it’s it’s been been a good, good run. So we’re visiting here today with Joe DeLuca. He is the founder of IP optimizers for information to engage in joselu IQ optimizers.com Be right back.

Alan
Since you can’t take your wealth with you spend time with your family. Welcome back, I’m here today with Joe DeLuca. And Joe’s during the break we’re talking about, we’re transforming into this it optimizes the case study. Can you share that with us?

Joseph
I’ll be happy to and it goes to one of the questions we often face is, in order to do some form of significant transformative change, do we have to have big data to do it? Or can we use little data that has little datasets, little analyses that have big implications, big results for the system. So early on in my career back in the late 70s, which will, which will date me we’ll go over that I was on a research project where we helped to build mathematical models to predict the probability of surviving a heart attack, or a trauma event or a burn event when you were in the field. And we use this to go in at the time and justify helicopter transport for what we now know for the golden hour. And to go into hospitals who at the time who didn’t have 24/7, emergency department physicians there and allowed them to allow the nurses who were on staff to do something as simple as open up an airway, which is really a mechanical skill doesn’t require a physician to be on site for that. And we were successful in doing that. And it immediately shot up the survival rates in the areas and the geographic areas that we’re looking at. So very small data set, that had a very significant implication. But it did something else it opened up in those communities, the medical professions sort of eyes to well, if we could do this in this one area, we can allow a nurse to open up an airway on someone, maybe there’s other things we should be looking at that are within their license, and would expand the service. So it basically then started a change process of rethinking what are the skill levels that are required to do certain types of procedures. And that is another sort of consequences that came out of that to where then different levels of care, different levels of practice were considered that wouldn’t otherwise have been considered. So small piece of data, leading to a big immediate, positive outcome, and then setting a cultural basis for moving further.

Alan
And now in the airports today, when you walk through, you’ll see a lot of these defibrillator centers set up.

Joseph
It’s another actual good example of that there’s small data sets that said if we put those out there, we can save. We can save more lives.

Alan
Yeah, unfortunately, I had a friend about a year ago that was on a boat and in the bay. I wish he was with a machine there because he had the the he died and that the autopsy said his heart just stopped beating in the defibrillator would have saved it. So sadly

Joseph
for For us men like 50% of the the first sign of a heart attack and 50% of the cases is death. So morbid way then. So

Alan
we’ll see more of this. What we’ll see is more of this into the future in terms of the procedures don’t need to be limited to the doctors, but could it be certain things that we can be engaged in to help

Joseph
where we’re up and we’re already seeing that and it’s not only through direct provision by medical professionals but also virtual care teams, there are new companies and new models of care where telemedicine it’s often referred to tele telehealth where you can get second opinions or have a physician remotely take a look at what your conditions might be. So a lot of expansion

Alan
in this in this DNA one things that you do as DNA analytics are making that available,

Joseph
we we help to build the databases that would help that right? And how

Alan
how, how convenient will that be for us to acquire in the future,

Joseph
it’s actually fairly convenient to acquire it today. So you can go through DNA testing services and get your profile. Basically, either a very narrow or very broad profile of developing get you information, both about your potential disease profile also gets you ancestry information, because that’s in large part what it’s based off of. And then those are readily accessible through secure web technology that you can then share with your provider physician or not one of the problems we have two of the problems. One is much of the medical community doesn’t know how to interpret that information. So we have it but what do I do that’s actionable relative to the care of Alan or Joe that’s associated with it. In the specialty cases such as cancer, those are developed into very, very specific sub specialties were at the academic medical center, Stanford, UCSF, others, you, you have the the tablet to be able to then say, well, here’s what I’ll do differently with this information. That’s there. So that’s one problem. The second problem is our computer systems. Our electronic health records haven’t quite caught up with this yet. So we can get a text based report like a lab report that says what’s there, but we really can’t get access to the direct DNA files. Some organization St. Jude’s Children’s Research Center in Memphis, Tennessee, they do quite a bit of scientific analysis at the bedside. So they do have capabilities that allowed them the physician and the care team and the scientists, the medical scientists to look and say, based off of this particular genome in this specific configuration, I can do something different for the patient at the bedside. So but we’re getting there, but you could do this now. publish it, you can publish your genome.

Alan
I’ve been visiting here today with Judge a look at Joe. Joe, we’re out of time today. But for more information on contacting Joe and engaging it optimizers you can go to the website it optimizers.com And look for Joe DeLuca. Joe instead a pleasure being able to keep you posted and thanks for joining us here in America dreams and join us next week right here on this station.

 

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This transcript was generated by software and may not accurately reflect exactly what was said.

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