The Value-Based Healthcare is back with a brand new episode! Our guest for episode 18 is Nicole Cable, the Chief Experience Officer at InnovaCare Health.  Nicole was pre-law before shifting to healthcare. She used her education and expertise to learn about the human experience and how it can be adapted in patients and hospitals. Nicole asks the question, "What can we do differently to ensure that we're able to deliver affordable healthcare that's safe and that has good quality?" Find out the answer to this question and more at the links below. 

Click play below to listen to the entire podcast. Scroll down to read the transcription.

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Podcast transcription: 

Jay Ackerman:
I'm back again with another installment of our podcast series, The Value-Based Healthcare Podcast. I truly look forward to these podcasts. I'm delighted to have the opportunity to do this while operating in a work from home model as we continue to adapt to COVID-19. Through our podcast we aim to widen the visibility and voice of people working to change how healthcare is provided, the impact it has on all of those who participate in the care delivery chain, and I'm thrilled today to be joined by Nicole Cable. 

Nicole serves as a chief experience officer of InnovaCare Health, a company providing managed care services, health plans and physician network services. She has served in a number of executive roles including Corporate Director of Patient Experience Programs for the ChenMed family of companies. In her current role, she is responsible for designing, implementing and evaluating programs to enhance the patient experience. Nicole has served as the Director of Patient and Guest Experience at University of Maryland Laurel Regional Hospital, the largest provider of healthcare services in Prince George's County, Maryland.

Nicole, welcome and let's get started. 

Nicole Cable:
Thank you for having me. 

Jay Ackerman:
Yeah, I'm delighted. So, first, why not spend a minute or two on operating during this pandemic? So, specifically I'd be interested in what you have done to keep the business running smoothly during the stay at home order. 

Nicole Cable:
We've had to readjust, obviously, for our employees and making sure we were providing them with the ability to work from home, but at the same time we had to move quickly in some of our business areas to get our providers to be able to deliver care in a virtual setting or either telephone setting. So, from a patient experience standpoint, we work quickly to create tools that were rooted in evidence for our providers. We were fortunate to have amazing leaders running our primary care practices and position leaders that were very open to trying these different tactics and getting the feedback from the providers as well as the patients. So, it's almost, I would say, baptism by fire but it's definitely been adjusting as we go along, in finding out what works and what doesn't work. 

I think one of the biggest opportunities I had also was collaborating with my colleagues that are experienced officers, or hold that role in different areas around the world. So, I'm a part of a group where we're meeting every week and hearing what John Hopkins or Cleveland Clinic or someone in Australia was doing to combat COVID and the different scenarios and situations they were having. So, it was nice to have that level of peer support that I could take to, bounce things off and even adapt some of the programs that they were doing to keep the business flowing. 

Jay Ackerman:
Thanks for sharing that. On the topic of what works and doesn't work, anything special you want to share regarding what you've learned about yourself during this period or about your team? 

Nicole Cable:
I would say definitely about us is that we probably need to be definitely a little bit more proactive. I think it's a learning lesson. I think for us we take care of all our seniors and while we know we probably need to help them with technology to make sure that they can adapt to and be able to see their providers quickly as possible, I would definitely say something I did in my former role at ChenMed, we put programs in place in our practices to teach our seniors how to use their cell phones, how to use iPads and things like that, and I feel like we have to do a better job of that now in our organization. And it's a little difficult because with most of our business being in Puerto Rico, and I'm pretty sure you've heard of all the things that have gone on in Puerto Rico between the earthquakes and the hurricane. It's just been a very trying time for our family there. We like to call our members our family. 

And so, I think moving forward we definitely want to be more proactive in how we get our seniors using technology. I do know the leaders of our organization are actually looking at ways of how we can improve our health plan offerings to help with that. So, it's great to be a part of an organization led by Dr. Shinto where we're focused on really seeing how we can take care of our seniors from a healthcare perspective. So I think for me the learning opportunity was moving a little bit more quicker in the patient experience realm of it, but very blessed to have a leader that was kind of reading the tea leaves, as they would say, and started moving us in the right direction prior to this happening. 

Jay Ackerman:
That's great. Thanks for sharing that, yeah, and for the people of Puerto Rico it feels like it's just been one punch after another for the last couple of years. 

Nicole Cable:
Absolutely. 

Jay Ackerman:
I'm sure it's kept your team on their toes. Maybe if we could just go a little further on the topic of the engagement model, anything you can share on how you've had to adjust that or think about it in light of supporting COVID patients who are quickly isolated from all by the essential care givers. 

Nicole Cable:
You know, I can say I'm very blessed to work with a great group of leaders, and we are all over the place. I mean, we're in Puerto Rico, we're in Florida, we're in New York, and it's nice to have people that really come together very quickly. I can say one of the things we did in partnership with marketing, our VP of marketing in Puerto Rico, she pooled a team of us together and we used our staff, because our CEO was very adamant about not laying people off. He wanted to repurpose the workforce, so that was his mantra. He was really driving us to do that, and it was actually very admirable when you hear about people losing their jobs. Dr. Shinto was completely opposite. He was like, "Let's redeploy our workforce to help us," and so we actually were able to use our employees to make phone calls to our patients, our members, to combat the loneliness and we were able to use our mental health professionals as well to help the patients. 

So, it was nice to see that and we had a lot of great feedback from our members, because they were isolated from their families, and our staff had the time so they could spend that time talking to the member, engaging them. So, that was one thing that we did differently that gave us a great outcome, was to redeploy our staff and to really look at engagement. Now we're working with our IT department from a perspective of our members app, which we have on our cell phones. How can we increase that engagement even through the apps that we have out there that our members have downloaded? So I think that was, to me, one of the great wins that we were able to accomplish during the COVID crisis particularly with our populations. 

Jay Ackerman:
For you as Chief Experience Officer, it had to be pretty gratifying to look behind you and all of a sudden see a vastly larger team engaging immediately with all the members or family members, as you put it. 

Nicole Cable:
Yeah, it is. It's a wonderful thing. I've been in this role for almost two years and... I think I might have made two years, two years, and I lived a lot in Puerto Rico. I was there all the time. I've got to say, their family, we couldn't have done this without them. We celebrated the employees as well, so during the middle of COVID and still in it, we have a thing with the The Beryl Institute in our field called Patient Experience Week, and that week is all about our employees. A lot of healthcare systems decided to delay the celebration until after COVID or people returning back to work. 

Well, a group of us leaders decided we were going to push forward, and we had a lot of different events across our whole infrastructure where we celebrated our staff. We had funny days, funny sock day, funny this day, take a picture of you doing this, and people would submit it and we'd vote on it and we'd give out prizes. We recognized staff, we recognized our providers that we work with and our IPAs, and it was very gratifying to see our staff and even our IPA doctors, pretty much repost their certificates or their recognition on social media, or write these beautiful emails back saying, "Thank you for appreciating us." It was very gratifying, and to see all of us across the company come together for that one week just to focus on the employees and to celebrate that, that was tremendous, a great feeling. It was definitely one of the highlights during our COVID crisis when we were able to celebrate those who were on the front lines taking care of our patients and members. 

Jay Ackerman:
Those are beautiful stories to share, thank you. I'd be remiss if I didn't go back a little bit and ask you to share, how did you find your way into healthcare and into the role that you're currently in? Can you share the story with us? 

Nicole Cable:
Yeah, absolutely. My path to healthcare was not a straight path. I did not have a desire to work in healthcare, was never my calling, per se. I love customer service. When I first started college, I was pre-law, which is totally not what I'm doing now, but I kind of got scared about that. I took a chance, moved away and ended up in Pennsylvania. I'm originally from Louisiana, so I'd never left the state, and I found myself working at a healthcare company, a mail-order pharmacy company, which was I guess my first healthcare job, and I never really thought about it until later. But it was a temp job, but I did it, and I found my way into a little company called Circuit City stores. There I learned everything there was about service and leadership and I loved that job. I am like many Circuit City alumni that cry when I think about what was and what happened to us, and learned a lot of lessons there from a leadership perspective on what I think our decline was as an organization. 

And so, I would pray to God, "Can I find a job that was just as rewarding at a company that's going to be around for a while?" And I landed in Marriott International at corporate and worked with some pretty amazing people. John Marriott at the time was my senior VP and I learned all there was about limited lodging and then full service and then brands, because we were opening new brands when I was there. I learned about service on Ritz-Carlton, so learned a lot about how the Ritz-Carlton captured that ‘guest for life’ and thought it was an amazing company, never thought I would leave. 

Suffered some health crisis when I was there and that made me sure that I never wanted to work in a hospital setting because I had lived in hospitals for quite some time being very, very sick and then I was recruited by this company for a job at University of Maryland Medical Center. And I don't think the recruiter really knew what the job was all about because he was a tech recruiter, but I did the interview anyway, went in, met an amazing guy named Johnny Carr and he sold me. He said he wanted to turn the hospital into Hos-Pi-Tel which was a hybrid of a hospital and a hotel, and I said I'm sold. So this is me, I'm feeling very psyched about this job and was very sad to leave Marriott.

Still stayed in contact with them just in case I had to go back, in case it didn't work out, but fell in love with the role and it was newly created and got to learn how to interact with the providers and patients and other clinical staff, and never looked back, and just found myself going to the next level, becoming a director, moving into a role where we were acquiring Laurel Regional Hospital as University of Maryland, created patient experience programs there, got on the radar of ChenMedical, interviewed with Chen and then relocated down here to Florida and learned as much as I could about value-based care, and which I'm very passionate about. 

I love what they've done. I talk about their model very often because I'm very proud of being a part of that team and creating those customer service programs for our patients, and then was blessed to have this job at InnovaCare Health working with Dr. Shinto. And so that's been a thrilling ride because I've never worked for a healthcare plan, and so that was something new. So, that's my journey from Circuit City to where I am now. 

Jay Ackerman:
That's great. It's a great story and a heck of a journey. I imagine there are not a lot of people inside of InnovaCare that started at Circuit City. 

Nicole Cable:
No, no, I'm going to say zero except for me, just me, and most people, the young people go, "I remember Circuit City," and I'm like, "Yeah, don't date me." 

Jay Ackerman:
For sure. Well that's great. So you mentioned value-based care and let's maybe now shift and talk a bit about the industry. So, what industry trends do you see that are beneficial to healthcare organizations? 

Nicole Cable:
I'd definitely say value-based care. I had an opportunity to talk about this to some students at FAU here in Florida through a lecture series that a colleague of mine has, and it turned to value-based care pretty much, because when I look at seniors and I look ... we're getting older. The population is living a lot longer, and so we look at, at least for myself when I look at it, I think of, what can we do differently to ensure that we're able to deliver care, affordable healthcare, that's safe and that has good quality? And so working at an organization like ChenMedical, I really got to see that as a full risk model. 

I was not familiar with that model at all and learned a lot from the leaders of that organization on how we were able to keep our patients healthier. And so I think organizations now, the trend that I see is about value-based care. I just saw the Walgreens article about Village MD and I'm thinking, this is huge because people need to be able to have affordable care and they need to be able to have really good doctors that are paying attention and delivering services that are required and that are needed, but bringing the patient in as a partner of that care, and I think while some organizations do a really good job at it, I think there are still opportunities especially in primary care to really bring that patient and their loved ones, or I like to say those they love, because a family member doesn't necessarily have to be a blood relative, but I think the trend I do see in some organizations where they're bringing them to the table and engaging them and activating them in their care is really critical.

So I would definitely say there needs to be more focus on managed care, but I would even say when I talk about people, I think about the human experience. How do we connect with people on a level where we are paying attention to their needs, their social needs, we're looking at their backgrounds and understanding why a particular group of people may not follow a care plan. How do we overcome that? And I think there's a lot of opportunity for us to talk about that and really raise that profile around how we engage members or patients of different populations in different segments of our society. 

Jay Ackerman:
Well that's, I think, a good segue into the next question around barriers with challenges that affect patient improvement in today's environment. On value-based care side, it's really important that the member take some responsibility for their own care plan. So, love to hear your thoughts on barriers or challenges. 

Nicole Cable:
I think for me I'll use an example, when I was doing my undergrad or my master's, but we had this case study and I actually saw it happen at work and I didn't really know how to deal with it. I heard a colleague of mine complaining about a certain patient that just didn't listen to their care plan, and I thought, "Wow, that's just silly." You would think you'd want to be engaged in your care and follow through with what the doctor tells you to do. Then when I started really peeling back the layers, I understood there was a systemic fear of healthcare providers. 

And so that particular patient that I actually got involved with had a fear of providers based on some historical things that had happened to her in her life. When we finally uncovered that and addressed it and explained to the provider why that patient was a little apprehensive, it actually created a better relationship and she was able to follow her care plan. She trusted her doctor, they built the trust, he got the outcomes he needed, she had a better quality of life, everybody was happy. 

So, I think while people do have to own it themselves, I think as health plans, we also have to look at people's backgrounds, socioeconomic backgrounds, and understand why people have challenges with following healthcare plans or being engaged in their care. I think it's easy for someone like me in healthcare to say they don't really care about themselves and they really need to be more focused, but I think as a provider of care I need to understand why that person finds it a barrier to listen to us, and who do I need to bring into the conversation to make sure that that patient understands why this is important to their healthcare. I think it's important. 

I think for us as healthcare plans, we have to do more of that. It's nice to see people like United Healthcare looking for staff in patient experience work, be a certified patient experience professional. I think when I saw that on LinkedIn, I almost had a fit. I was tickled pink because I couldn't believe that a company as large as United actually knew what our certification was and was actually looking for people to have that, because through that certification, you're looking for all those different lenses of what could be a barrier to someone seeking care or hearing to care, and I think the more knowledgeable we become of that, the better outcomes we'll have in the future when dealing with patients and their families, because that's so critical to what's happening. 

Jay Ackerman:
You know, I appreciate you mentioning that about United. As I shared with you, before we got this podcast rolling, I was thrilled to have the opportunity to talk to you here about what the role of a Chief Experience Officer is all about, and maybe to build on that, do you see this role growing in prominence inside of other plans? You mention United. Are you starting to see it pop up elsewhere? 

Nicole Cable:
Yeah. It's a patient experience role where they do analytics, so it's not the chief. To be quite honest, I've looked and I've even asked my colleagues; - I'm a member of the Beryl Institute and we're a pretty large organization. I think we're the largest around experience and close to 70,000 members in over 80 countries and there are no healthcare plans that have a Chief Experience Officer that I know of. I think the role sometimes gets absorbed in marketing or either in HR and I think for me, and I'm blessed, I have an HR partner that I work very well with. So what happens for me is I see... I advocate for one area for the employee. She advocates for another, and so we actually took the idea of the Maslow hierarchy of needs and said she handles the base and I got the top. 

Because we have to get the staff to understand the providers and everyone, even the staff that are not our direct employees, why the work they do is so important. And so I hope that it grows in healthcare plans. I think it's needed. There's a lot of opportunity there to understand the patient experience. I know we're member-centric but our providers are delivering the patient experience. And so, like I say, I came from ChenMed and I remember being at Chen, I was able to create those programs around patient experience, and I'm not going to mention the healthcare plan but the healthcare plan that I worked with, one of them that I work with was actually trying to tell me about patient experience and they had created this beautiful brochure that they wanted us to share with our patients and I looked at... 

I said, "You know this is written at the 13th... This is written for a college junior. This is not written for an eighth grade or a sixth-grade reading level. This is written at a college level. So in good faith I can't see us using this for our patient ... I can't see this for any patient population." And so, it became... and even the graphics. You can tell they didn't run any sort of health literacy assessment on anything. It was just ... it looked pretty, it had Google fonts, it was light background, it was everything that you learn never to use when educating patients or members, yet it was beautiful. Someone like me could appreciate it. I think I'm smart enough to go, ‘this looks really hot,’ but is it for me or is it for the people we're serving? 

And so I think from plan's perspective, I don't think they necessarily write or build for the people they serve, and that's not all plans. I don't want to throw anybody under the bus and say everybody needs help, but I think in healthcare in general, I think that's an area of opportunity for us, is to look at who we're serving and then partner with people in the community and other organizations to make sure that what we're giving our patients, members, or human beings because that's what they are, meets their needs. Bring your patients in for an advisory panel, not a focus group. Please not a focus group, but advisors. Bring them into the governance of your organization. Get them involved. Ask them what they think. Ask them what they like and do that. 

There are very few healthcare plans that use patient and family advisors and I know that because we're in the process of building one for our plan in Miami and I reach out to the Institute for Patient and Family Center of Care... they're, to me, the thought leader in all of this, and I think it was maybe four plans she was able to tell me that were doing it, and they weren't the corporate umbrella of the plans. They were the local offshoots of those plans, which was a little depressing but it wasn't a big, there wasn't 20, 30 plans that were using their members for this type of work. 

Jay Ackerman:
Interesting. How about changes to the patient experience during COVID and any thoughts on learnings, adaptations during this unprecedented time that you expect to kind of have a lasting impact on how care is delivered? 

Nicole Cable:
I think it's going to be more; honestly from a patient experience standpoint, I think organizations are going to be looking to go more into telemedicine, I think a lot more, because of COVID, because we don't know when the next; I don't say "new normal" because there's nothing normal about what we're going through, but our new existence, and so I think with the new existence that could occur with other unfortunate pandemics that may happen to us in the future, I think we're going to probably be looking more at how do we educate our patients and their families on being a part of their care teams. I did hear in our organization and other organizations, I know they were involving the family members for the appointments which is really nice, so; and the family members really appreciate it because they could be there with their loved one and hear what was happening, which was something that we didn't necessarily do all the time in the past. 

You might not want to have a patient and a family member in the room when you're doing the exam but now that we're doing this virtually or telephonically, we're seeing people really like it and our physician practice groups out in Orlando, the leadership has done an outstanding job with moving very quickly to doing those type of visits and the feedback from the members have been very positive. We're still doing surveying with those members through text because we were doing them in person like a point of service survey. We obviously had to rethink that since everybody was coming into the practice and we didn't want them touching things they didn't need to. 

But the feedback has been positive so I think as we look at post-COVID, current COVID, we're going to have to be more creative in how we educate our patients and help them feel more comfortable with using these tools as well. Like I said earlier, when we were at Chen, I was there four years ago, we were already hosting classes for patients to learn how to use their technology. I think part of that was the reason they were able to go so quickly to pretty much all their patients doing telehealth. 

Jay Ackerman:
That's great. All right, let's turn a bit internal. What advice might you have for healthcare executives in navigating our industry during these kind of, rapidly changing times and a bit tumultuous times? 

Nicole Cable:
I would say listen to your employees and engage your employees. It's very important. I think that my CEO is a good example of that during COVID with staying connected with our employees, letting them know we care, updating them, over-communicating to some degree what was happening in the organization and his commitment to them. I think as leaders we have to; they're human beings, taking care of human beings and so no matter where they are on the spectrum, they have concerns as well. Do we reopen now or do we wait? Do we do this? Do we not? And so I think having someone that was very transparent on what we were going to do in our next steps with our staff and really leading us through this, I think, really brought us out on the positive and on the other side and so I think even if something else should happen, God forbid, particularly in Puerto Rico or anywhere else because we're in hurricane season coming in Florida, I feel very confident that his leadership has helped us. 

I would say part of that, again, is listen to your employees, really paying attention and adapting what you can of what their recommendations are. I think we sometimes get so caught up in the day to day and the whirlwind that we fail to listen to those who are actually at the front lines, and I would say that for all of our leaders that are running the various markets especially here in Florida. Our CEO of our plan here has been very passionate about the staff and listens to them and is always available to them, and it means the world to them. It's definitely a different type of organization now that we have these amazing leaders here that do listen to the staff. 

Jay Ackerman:
That's great. Thank you. What about turning toward CMS? Any thought on regulation changes you'd like to see from CMS that would be most beneficial to members? 

Nicole Cable:
You know, I would say; we were just having this conversation this week which is interesting. So, you know how we have regulatory bodies such as Joint Commission coming into your hospitals and making sure you're doing everything right? I think CMS needs to look at the primary care practice world. This is my patient hat on. I feel there's opportunities, I think, for patient care. You have to almost kiss enough frogs to get a prince to find the right doctor and as a patient I went through that. I swear I must have had 100 frogs and then I finally found my prince and I never wanted to leave it and I stayed regardless. I followed from the ends to the moon. I'm like, "Okay, do I have to change plans so I can follow you?" I'm going to do that because they took care of me. They cared about you as a whole person and I think sometimes it's very transactional, and I hope CMS is looking at, especially for plans, at elevating the patient experience aspect of it to a higher weight, especially in the coming years. 

So, I support it. I think that it's overdue. I think surveys may not be our best friends but I think it's the best way to get our patients' feedback as it stands now and for those who do not think it's valuable, then come up with a better idea, but for now I think hearing the voice of our customer is very important, and I hope CMS starts to regulate that a little bit more with primary care practices because sometimes they do things that are so backwards and you've really got to scratch your head with some of the processes that come into play for patients when you're trying to seek care. So, I would definitely hope that there's more regulatory around practices to make sure that they're safe for us when we're going in and that they're clean as an infection control issue and making sure that there's some standards that are followed. 

I like the fact that I see some, I think it's CVS Minute Clinics are Joint Commission accredited which blew my mind. I'm going, "Really? You're Joint?" You know how hard it was to be Joint Commission accredited in a hospital but to see their clinic thought that that was important? I think that's pretty neat. 

Jay Ackerman:
Fantastic. All right, how about for the public? Any recommendations you'd have for the public regarding their own empowerment and ownership of their own health? 

Nicole Cable:
Absolutely. I would say educate yourself. Do not be afraid to ask questions. You have these health plans that have a wealth of experts employed, providers that they contact with. You need to ask and advocate for yourself. You're being a patient. It's scary because you really don't understand the language, sometimes, of what they're saying and this is post coming into healthcare. Even now I work in healthcare and I still have to ask, "What are you saying?" I still have to scratch my head because you have so many things floating around in your mind that when you're being told your diagnosis or your treatment plan, you don't necessarily absorb all of it. 

So I definitely tell our own patients and our members, "Bring a notepad. If you could bring someone with you, bring someone with you to have a clear head, but definitely take notes to what the person is saying, because you may not remember all of it when you finally go home and start processing. And don't be afraid to ask questions or ask them to explain it in a way that you can understand, regardless of your educational level, because I think sometimes, we don't want to feel that we're not smart enough, but we need to not do that. We need to ask. 

Jay Ackerman:
Yeah, no, that's great advice. I've had to give my father that kind of advice as he sees doctors. He's always put them on a pedestal and he's unwilling to ask questions when he's in a care setting. 

Nicole Cable:
It's the white coat syndrome, and it's interesting because I tell the doctors; I love our providers and I've been blessed to work with a lot of doctors around the country, and they are just amazing. What I have learned is it's not that a doctor doesn't want to do the right thing. They just don't know how. They're not taught this in school. So when you explain to them the seed of conversation and if you do this, you'll elicit this response, if you say this, this will give you that response, they really do soak it up like a sponge because at the end of the day, they got into this to help people, not to hurt people, so if you give them things, evidence-based obviously, that works, they're likely to adopt it. 

And so we work with our providers to ask those questions. "Mrs. Smith, is there anything else I could help you with that I haven't answered today?" Do the teach back model, making sure that the patient feels comfortable asking those questions and having that conversation. So, I think that's something else we'll probably need to do a better job at, is really helping our providers deliver better service by training them on those different tactics around the patient experience. 

I haven't met a doctor, I've met a lot that have ever not wanted to improve the patient experience, so it's, again, just helping them with those tools, I think that matters most and then that gives the patient the ability to ask the questions and be candid, and it gives the doctor a chance to do what he or she really wants to do, and that's to deliver quality healthcare. So, definitely a two-way conversation. 

Jay Ackerman:
Dynamite. All right, well I should probably let you get back to your core job, but before we do, let's move to kind of the rapid-fire round to wrap it up. 

Nicole Cable:
Okay. 

Jay Ackerman:
So, five questions for you, kind of top of mind, no right, no wrong. So, what keeps you up at night? 

Nicole Cable:
Oh, healthcare for those who do not have access to it. That's a tough one for me. Coming from a low socioeconomic background, that hits home, and how we can improve it. 

Jay Ackerman:
Yeah. That is a tough one and certainly a lot of work trying to undo something that I think has brought healthcare to a lot of people who didn't have it. So, when you are restless at night kind of tossing and turning over that topic, what book might you grab from your nightstand and why are you reading it? 

Nicole Cable:
One of my go-to books, and I'm actually reading it now, again, is Hardwiring Excellence. I'm a huge Quinton Studer fan. I love this book. Sometimes I need to just read. My brain is going a thousand miles a minute and I have to center myself, and I go and I grab this book and I think about my purpose and how I want to make a difference, and then I just follow some of the tactics that he lays out that I adopted many years ago. It's just a nice way to go back and repurpose and kind of re-center myself and make sure I stay focused on what I want to do. 

Jay Ackerman:
Great. I actually saw somebody's tweet on Twitter yesterday who was asking for people to identify the book that they're rereading right now as the call out to something that obviously is having a big impact. So thanks for sharing that one. Favorite app on your mobile device? 

Nicole Cable:
Amazon Prime. Anything Amazon. I'm sorry, I'm an Amazon nut. I love Amazon. It's the best thing since sliced bread. I use it probably every day which is ridiculous but I do. 

Jay Ackerman:
Well, someone who appreciates the way a company serves its customer, I can imagine why it creates a connection for you with them. 

Nicole Cable:
Yeah. 

Jay Ackerman:
How do you invest in yourself? 

Nicole Cable:
I actually like to read and I love taking classes; I know this sounds bad, but I do. If I see something I want to do, personally I love photography, I'll take classes in photography. If I want to get better at process improvement, I go in and will get a belt, so I’ll go get certification in Six Sigma. So I always try to find a way to improve myself because I feel like every day is an opportunity to learn, and I love being around people that are smarter than I am, and understanding how they see the world and what they do differently, it really helps me get better at what I do and be a better human being, so just surrounding myself around greatness and just reading it and making myself better, whether it's learning a new skill or enhancing a skill I already have. 

Jay Ackerman:
As I was acquainting myself with your background, I did notice the numerous Six Sigma belts that you have earned. So, thanks for highlighting that. All right, last one. What's the most creative thing that you have done during your stay at home period? 

Nicole Cable:
Oh, that's a good one. The most creative thing I have done…

Jay Ackerman:
That can be shared (laughs)

Nicole Cable:
That can be shared (laughs). Okay, yeah, that's a good one. You may want to put that as a caveat. I would say since I've been home, me and Amazon have been best friends. 

Jay Ackerman:
Oh no. 

Nicole Cable:
On a personal level I have actually purchased; because I have this house that I got and I never am in it because I was always in Puerto Rico. Now that we're not traveling, I'm home more which is fabulous and I live on a lake, so I bought a hundred-foot screen and a projector so that I can have my godson and his siblings come over to watch movies in the yard. They can't come now, but in a couple weeks I'll have them back, but that's what I've done. I've created my own outdoor theater, and so I am totally psyched about that and love it. So, very, very proud. 

Jay Ackerman:
That's awesome. Well, if it's 100 feet then I imagine that a lot of your neighbors will be able to enjoy that too. 

Nicole Cable:
You know what? I think they will. They're pretty cool, so if one's not cooking out, one is having a pool party, so I think we're good. 

Jay Ackerman:
That's fantastic. Well Nicole, this has been great. Thanks for your time and your openness. 

Nicole Cable:
No, thank you so much, I really appreciate it. 

Jay Ackerman:
Yeah, same here. This brings our Value-Based Healthcare Podcast to a close. Please follow Reveleer on LinkedIn. You may also follow me on Twitter @AckermanJay, over and out.