The Value-Based Healthcare Podcast: Dr. Oz

Dr. Oz is our special guest for Episode 21 of The Value-Based Healthcare podcast. He is a television personality, cardiothoracic surgeon, Columbia University professor, journalist, and best-selling author. Listen to what Dr. Oz has to say about the inefficiencies of healthcare that came to light during the COVID-19 pandemic, Medicare Advantage for all, and the applications of AI in healthcare.

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Podcast transcription: 

Introduction:
Welcome to Reveleer’s Value-Based Healthcare Podcast. In every episode, we discuss healthcare technology, innovation and current events. Presenting interviews with thought leaders from a variety of disciplines of healthcare. Don't miss any episode by subscribing to the series via reveleer.com. And now, here's our host Jay Ackerman introducing today's guest.

Jay Ackerman:
Good afternoon and thanks for joining me.

Dr. Oz:
Welcome.

Jay Ackerman:
Hi, Dr. Oz. Let's dive right into a hot meaty topic. The Affordable Care Act. What do you think it got right? And what would you improve?

Dr. Oz:
Well, what I would improve is, make it a document that could be carried by a human being. If you have thousands of pages, it's going to be very difficult for people to understand it. In fact, we know for a fact that it wasn't really understood. Very difficult to implement it. And you end up with a lot of very smart people spending a lot of time just to get it to function. And I know some of those people and they work very hard at it. But when the president at that time, Obama, said that you're never going to lose your own doctor, I do believe he thought that was the case. But who could have figured that out with all those competing agencies and entities. But what it got right, without question, is it dramatically reduced the number of uninsured people in America. And that was the ultimate goal of that Act.

I actually think that we may have opportunities now to do an even better job of reducing number of uninsured which we cannot allow to continue in America. It perverts the system. It makes it very difficult to implement a general preventative healthcare approach. One of the problems with COVID response I think is we don't have that broader public health foundation, culture within healthcare because it's not based on prevention. It's based on treatment. Which is one of the reasons so many of our healthcare facilities are having trouble. 8% of doctors I just read, and nurses and others are trading in the profession so to speak. Because sometimes they can't make ends meet because there's no healthy people or keep people who have illnesses who need treatment outside of COVID, who are coming to the office because they're all worried about COVID.

And in most healthcare systems, you'd be based seeing your revenue on prevention so it wouldn't cause as much pain. I personally am a fan of Medicare Advantage for all. It's an idea that probably has some merit that has not been fully evaluated. It has limitations as well, but it might be a simpler way of using an already existing program that seems to function and getting all America covered.

Jay Ackerman:
So what would be the one headline around Medicare Advantage for all of that that you would share so that people understand what it really means or what it doesn't mean?

Dr. Oz:
Medicare Advantage is basically a Medicare HMO. So whether you like HMO's or not, there are managed care approaches to dividing care which many Americans are very happy with. It allows you to get a lots of extra benefits because there's more bang for the buck because not a lot of wastage allowed because you're managing the care and reimbursing and benefiting high-quality care when done correctly. And it's worked for the Medicare population. About a third of Medicare beneficiaries are Medicare Advantage. And because of that, they get additional perks that allow them to benefit. They don't get charged any extra.

And so that's the good part about it. We already have a plan that works. So you could extend that to a younger population under the age of 65 in a variety of different ways, but at its very core, probably 30% of the payroll tax, or I should say 30% of the salary of an employee makes is dedicated to healthcare one way or the other if the company is involved in paying for it.

So we could take that same money and have others contribute as appropriate, basically cupboard everyone to Medicare Advantage. And you'd probably be able to cover people even those who are not employed because 30% is more than you'd need. To be able to afford the healthcare system, you probably need 20% of the payroll of America to cover healthcare. And so, you'd be able to provide care to everybody else for an aggregate less money for a covered employee. So, companies would be okay with it. Employees should be okay with it because they'll recover more widely. The healthcare system would understand the rules better.

And I think because the modern American experience, if you create rules that are understandable and followable without overlapping agencies not even knowing what the true effectiveness of the regulation, how to have been implement it is, then we can actually make a system that cohesively functions. Let's take advantage of the digital technologies that already exist to create a cohesive healthcare system that achieves our goal. Better care for less money. And the most expensive care of all is bad care.

Jay Ackerman:
So you're talking about Medicare Advantage. Then I kind of put that in a bigger bucket of government sponsored care and a big part of government sponsored care has been the push to value-based care over fee for service. Where do you think we are in that continuum?

Dr. Oz:
It's getting better. I think Medicare, because it's got such a huge bucket of revenue to distribute can put value into the equation. It's harder for smaller insurance companies that know their covered beneficiaries shift every 18 months to do that. Just to be clear, Medicare Advantage is... The money comes from government but the actual implementation comes from private sector companies like it does for Medicare Advantage. But you go to large private companies, they are theoretically really nimble and able to do value care calculations and implementation. And you let them actually dole the money out in the best way possible.

And I think that's probably a better way of doing it than having it organized at the federal level where it's just difficult to have a federal entity customized care, the local communities and states that are so different from each other. But the funding process could be done at a universal level. Because those rules will be applicable across the country no matter where you're in a small little place down in Louisiana or in the middle of Midtown Manhattan.

Jay Ackerman:
Do you envision value-based care arrangements being kind of the fundamental norm for how we pay for healthcare?

Dr. Oz:
I do believe value-based approaches will be the foundation of effective healthcare system. As a practicing physician, I can tell you the most expensive thing that we do in healthcare is provide fractured path of care where people don't get a comprehensive, cohesive management around the complicated things that are happening to them. And it's difficult for the patient, their families, the doctors, no one likes it. And it's very expensive because it's inefficient. And all of those are improvable but only if you have everyone playing by the same rules or at least have one spreadsheet that you're on.

If someone comes to my office for care, I really have no idea, nor do they about whether they're covered or not, how much are they covered for, I have a whole staff of people who only do that. All of that by the way, great jobs, but we really want to pay that money for a middle management just to be able to figure out and arbitrate who gets paid what. And that's existing in every doctor's office, every insurance company, every hospital system. We all have those large infrastructures completely designed to deal with the complexity of the system.

And when there is complexity, the better you understand their system, the more you can game it. Which means people do get paid sometimes just because they understand the system. Not because they provide better quality care.

Jay Ackerman:
I don't know if this number is accurate or not but I've heard recently up to 30 cents on the dollar going into administrative.

Dr. Oz:
I've heard similar numbers. About a third of the healthcare system. What I was going to say, if you had a third of the healthcare system goes to administrative elements, probably half the healthcare expenses go for chronic illnesses. Which are better managed in a preventative approach rather than episodic when people develop symptoms. You're talking about a lot of the healthcare system that has kept us apart from each other on finding a solution that could be addressed. And so instead of quibbling over the pennies about who's going to pay for what, where, well, we know ultimately, if you get sick, you're going to get care. Just, is it free care where they get paid in the backend, is it fully paid, Cadillac service and everything in between? But the total amount of money that's consumed is, I mean, or at least the resources that are consumed are going to be the same.

Because if you're having a heart attack, you're going to still get care. So let's just do it in an organized way so we're all incentivized to prevent the heart attack rather than trying to treat it. My dad, who was a physician, just lost him, he was 93 years of age. But always tell me that the old Turkish proverb, which it takes one fool to throw a penny down a well and 99 wise men to get it back up again. We've got a bunch of wise people looking in down in the well trying to figure out how to pull that penny up, but let's prevent the penny from getting tossed in the first place.

Jay Ackerman:
Well, that's a great proverb. Let's zoom out a level. What are you most excited about in the world of healthcare?

Dr. Oz:
I love the fact that science can work cohesively. Ability to create a vaccine in 10 months against COVID-19 is a great example of that. Not just one, but numerous of vaccines. Many of which are going to work as effectively as the ones we know about already. And this is a shortening of a timeline that's usually 5 to 10 years to 10 months. And we already have the product already paid for by the government. So, it demonstrates you can cut red tape without cutting corners and create an incredibly high-quality result. And the ability to create a vaccine which will change the destiny of the human race at least for the next year or two, also means we've got tactics that might work for future illnesses and cancer and other therapies. So, the science is rapidly advancing and much more sophisticated lead addressing chronic illnesses we didn't think we had answers for. That's the best solution of all for everybody.

Everyone's happy about it. We just need a funding mechanism to pay for it. Right now, it's cobbled together at times when we put our mind to it, as it happened with COVID-19, anything's possible. When you break it into little fractured elements, it doesn't work so well. I'll give you one reliable example. A good friend of mine is responsible for the Joey Foundation. Joe O'Donnell is his name. Joe had a son who passed away from Cystic Fibrosis. He and his wife Kathy, who were pained by this beautiful young boy who was able to live for 13 years. But when he passed, they didn't know what to do. So, they put their grief into creating a foundation that took business approaches to finding solutions. At the time as you know, having Cystic Fibrosis was a death penalty. And over the course of several decades, they took all their money, they invested it together with other Cystic Fibrosis patients and their people who care about them were donating money.

And they started putting money into solutions that they believed would work. Even though in large companies saw it as an orphan illness, they weren't going to deal with it, tens of thousands of kids were dying from it. So, they were able to fund research that resulted in solutions that they were able to sell to pharmaceutical companies for billions of dollars because these treatments really do work. And they took that money, they put it back into better ideas to make better solutions. They again sold to pharmaceutical companies for billions of dollars. And now they've crafted this juggernaut, which has allowed us to treat 95% of Cystic Fibrosis patients successfully. You take a pill and you don't die of the disease.

It's pretty straightforward math. And they take that money and they're now putting it into multiple sclerosis and ALS and other illnesses we've all heard about but never could do much about. That's a innovative mechanism of taking private techniques with public solutions and marrying them so we get the answers we desire.

Jay Ackerman:
That's a great story. And going back to the COVID-19 vaccine. I mean, it's pretty remarkable that in a period of 10 months that we can have several vaccines getting ready to come to market and a cycle that normally takes 5 to 10. I'm sure a little bit behind that is AI. So, let's talk about artificial intelligence and the impact you see it having in healthcare over the next five years. Any thoughts?

Dr. Oz:
AI is the most important advance that will affect medicine in our lifetime. It will allow us to both prevent some of the simple errors by providing decision support. So you, your doctor, everyone involved, will get clues, hints about where to look. Where the problems might be, identify symptoms early, so they can be managed more rapidly, discover whole new ways of treating people who have life-threatening problems just by understanding a bit more predicting with the more sophisticated analytics what the best approaches are. And most importantly, it will make our treatment current with what our research is. Right now in medicine, it takes years for new ideas to percolate through the healthcare system. And by the time they're finally used, it's always ancient data that's guiding today's care. With AI systems, we're going to be able to say based on what's known today, plus all this data that's coming in to teach us what's happening currently, the best way to manage heart failure is bold.

And you had a kielbasa last night. Because of that, you put on two pounds and we know that from your internet everywhere scale that's connecting you to remote patient monitoring. Now your doctor immediately has an algorithm or automatically allows you to take an extra water pill to get rid of the salt water from the kielbasa and your kielbasa doesn't end up landing you in the hospital with a life-threatening exacerbation of your heart failure. And since heart plays a number one DRG in America, we can see where there's a multiplier benefit there. And AI, although it's expensive to develop, the results should more than pay for it. The real challenge is who's going to own AI in medicine. And I would love that to be a little bit more open source so everyone can benefit from it.

Jay Ackerman:
Where do you see AI having an impact today?

Dr. Oz:
Well, the most practical things I would focus on are the chronic illnesses that drive half the healthcare budget. Because many of them are seen as tedious, time consuming, not so rewarding aspects of being a doctor. Family practice guys don't get up in the morning and say, "How do I treat diabetes today?" And so, the ability to put AI as an interface to look for subtle clues of behavior that we know will impact on your diabetes, hypertension, your cholesterol issues, your asthma, your allergies, whatever would be great. And then you have a sort of a doctor extender as a tool that can immediately be a coach in the pocket of the patient. Giving them the advice they shouldn't hear from their doctor if the doctor was in their pocket. But we don't fit.

Jay Ackerman:
No, that's a great way to think about it. The doctor extender. Well, Dr. Oz, it’s been a great dialogue. Let's start to kind of wrap it up with sort of a rapid five. So, five things, real quick. What keeps you up at night?

Dr. Oz:
The belief that we will not provide healthcare to everybody. And as a derivative of that, we therefore will not truly have a preventive healthcare system.

Jay Ackerman:
So while you're kind of, ruminating over that and sleepless nights. What book might you pick up from your nightstand? And why are you reading it?

Dr. Oz:
There's a great book written by The Stand Together Institute which I would recommend to everybody. So, there's a great new book that just came out. It's called Believe in People: Bottom-Up Solutions to a Top-Down World is written by Charles Koch and Brian Hooks. They're leaders of The Stand Together Foundation. And what this book, Believe in People, basically says is, this decade, we need to focus more on bottom-up solutions by letting people, innovative social entrepreneurs come up with answers that we then fund and it can be funded through private philanthropy. We don't have a need to bring the government into this.

But if there are times when you need the government to adjust for example, criminal justice reform, which The Stand Together Foundation were major proponents of in large part responsible for achieving in 2018. Because they have the ability to mobilize people and point out that there are simple things that as a nation, we should do that are non-partisan. And I love the idea that if we believe in people, as Americans always have, then we'll be able to give them, empower them, to be change agents. That's what this country has always been about. We were inventors at our very core, and that's why we're not called United States-ians. We reinvent ourselves continually and this is a time for us to do that again.

Jay Ackerman:
I love it. That's a book I have to pickup, Believe in People. All right. So favorite app on your phone?

Dr. Oz:
I've just an app called SleepScore. Which is a really cool app. It takes advantage of the audio part of the bottom of the phone that cannot just make noise, but listen to you as well. And it has a little sonar that comes out like a dolphin. At night, I put it on my bed stand and measures exactly how well I sleep. It's the most meticulous sleep tracking device. And it tells me whether the quality of my sleep was good or not, how long, all that stuff that you want to know, but then it grades you. So, I actually race myself every night when I go to bed.

Jay Ackerman:
Well, that's fantastic. I've been relying upon the SleepScore and Fitbit. So, I'm going to have to check out this app. All right. What do you do to recharge?

Dr. Oz:
I do a lot of yoga. Actually, physical activity helps me recharge by resting my mind. What wears me down the most is when I'm thinking all the time and not letting my body get involved. So, getting a little flexible in my body, as well as a little strength training. It's physically rigorous to do power yoga, but as soon as I do that, I get myself into a place where I can meditate and that frees me to connect dots and be more creative than I ever would have been.

Jay Ackerman:
Awesome. All right. So, on the creative thread, what's the most creative thing you've done during this kind of shelter in place period?

Dr. Oz:
I started playing piano again. And we now have family competitions, where there are a bunch of cool apps on phones now that can make you a much better piano player than I ever was. And so, some of the kids sing, some of them perform, some play piano or guitar. So, we have a little family band. Then when we're tired of that, we'd go play Rock Band on the video.

Jay Ackerman:
Love it. It sounds like a really fun home. Well, Dr. Oz, thanks for joining us on The Value-Based Healthcare Podcast today. I really appreciate your time.

Dr. Oz:
God bless you. Good luck to you. Take care.

Jay Ackerman:
Great. Thank you. Over and out.

Dr. Oz:
Over and out.

Close:
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