Ep 97 – Breaking the Rules to Reshape Healthcare in the Post-Pandemic Era, with Dr. Robert Pearl

This week, we have as your guest the legendary Dr. Robert Pearl, a Stanford University professor, Forbes contributor, bestselling author and former CEO of The Permanente Medical Group.  Coming off of his bestselling book, “Uncaring: How the Culture of Medicine Kills Doctors and Patients” and a series of articles in Forbes about “Breaking the Rules of Healthcare”, Dr. Pearl describes the key economic and cultural forces that will reshape healthcare in the post-pandemic era. He highlights the flawed system design of our fragmented industry and how that has perpetuated economic status quo in the decades preceding the pandemic.  Dr. Pearl describes a better future for our healthcare system once we move from fee-for-service to capitation. In this podcast he provides thought leadership and sets a bold direction for a better tomorrow, while sharing lessons learned from his leadership experience at Kaiser Permanente and how COVID-19 will serve as a strategic inflection point to bring scalability to value-based care.

Episode Bookmarks:

01:45 Introduction to Robert Pearl, M.D.

03:50 COVID-19 as a strategic inflection point and how rules of industry (and society) are changing

05:40 System vs. Culture in medicine and the impossibility of separation

06:00 The consequences of cottage industry design and fee-for-service incentives in American healthcare

08:00 The trajectory of rising healthcare costs over the next decade and missed opportunities for social investment

09:45 How COVID-19 will change the rules of physician culture

11:00 A medical history lesson (ex: Ignaz Semmelweis and the pioneering of antiseptics) and how it relates to lack of progress in the modern-day

14:00 Why medical culture is holding back innovations that improve care outcomes (and how COVID-19 has exposed cultural flaws in the profession)

16:45 The positive aspects of physician culture and the heroism of physicians during COVID-19

19:30 The need to value primary care and prevention (over specialty care and intervention) and the impact on primary care on life expectancy

20:00 Why were Black patients 2-3X more likely to die from COVID-19 than White patients?

21:00 How physician culture tolerates low value care and the high frequency of personal bankruptcies of patients seeking care

23:00 How COVID-19 accelerated the adoption of virtual care (and why the culture of medicine continues to oppose it)

26:00 Why capitation is a better economic model to improve care outcomes

27:00 The impact of Private Equity on value-based care and digital transformation

29:00 How post-pandemic economic pressures will reshape care delivery and support VBC adoption (i.e. virtual systems of care, employer-led initiatives)

32:00 Dr. Pearl reflects on the Haven venture and future steps to be taken in healthcare by Amazon

33:00 The anger, denial, bargaining, and depression that will be experienced during the process of reshaping American healthcare

34:00 “Acceptance of change will be the opportunity to make American healthcare once again the best in the world.”

36:00 How digital transformation, AI and interoperability can eliminate friction in the healthcare value chain and create a new era of patient consumerism

39:00 The advancement of medical devices and wearables that will support advanced analytical capabilities in diagnostics

43:00 “The key step to reshaping healthcare will be moving from fee-for-service to capitation.”

50:00 Lessons from Kaiser Permanente’s success and why their full-risk model hasn’t shown scalability at a national level

52:30 How post-pandemic disruptions and virtual care models will bring scale to value-based care

53:30 Dr. Pearl explains how the government push towards value-based care actually began in 1932! (and how the AMA quashed the move to capitation)