Reveleer welcomes you to Episode 5 of  The Value-Based Healthcare Podcast. Our guest on this episode is Dr. Josh Luke, Adjunct Faculty of the USC Sol Price School of Public Policy and the author of "Health-Wealth for You: 11 Steps To Save Big & Live Healthy." Dr. Luke is an experienced hospital CEO, health system Vice President and nursing home administrator, as well as motivational speaker. 

This series aims to assist health plans become more successful through shared experience and best practices used by their peers in the industry. We interview executives at all levels within Risk Adjustment and Quality Improvement groups to share various perspectives. 

The Value-Based Healthcare Podcast is about sharing inspiring and real-world solutions from the people who are questioning the way business has always been done. We aim to educate across the spectrum of healthcare so that managed care organizations, providers and members alike are more successful in navigating and operating in this complex and ever-changing landscape. Subscribe today to ensure you receive the latest episodes!

Podcast transcription: 

Jay Ackerman, CEO of Reveleer:
Hello and good day. I'm Jay Ackerman, CEO of Reveleer; - a software and services company committed to providing health plans with innovative technologies to maximize their return from quality, risk adjustment and compliance initiatives; a must in the value-based care world we operate in. I'm back with another installment of our podcast series ‘The Value-Based Healthcare Podcast.’ We aim to widen the visibility and voice of people shaping significant functions inside of health plans. I'm thrilled today to be joined by Dr. Josh Luke. Dr. Luke is a veteran hospital CEO, a Forbes Books featured author, a leading international speaker and a faculty member at the University of Southern California. Dr. Luke is on a mission to use his years of knowledge and experience to help others break free from the entrapment of the current healthcare delivery model. Please enjoy this podcast and feel free to share it on social media and forward to others. Dr. Luke, Let's begin with a few questions regarding your career journey. How did you find your way into healthcare?

Dr. Josh Luke, Adjunct Faculty of the USC Sol Price School of Public Policy and author:
Before I do that, thanks for having me on the show, Jay. I appreciate thought-leaders in the healthcare space like yourself and anybody who's willing to take the time to do such a high-quality podcast to just advance the cause of coordinating care and really improving care for those who receive it. So, thank you to you and to Health Data Vision for doing that.

So, my story is a little different. I had two older brothers that were professional athletes. I remember sitting there on the bench my senior year in high school, watching my teammates play basketball and probably should have been thinking more about the game, but some of my brother's walk in and is home from, you know, whatever he was doing at the time, and I'm like hey you know I'm sitting here on the bench watching my teammates maybe I'm not gifted like my brothers to be a pro athlete, maybe I should consider an alternative career path. Just in case being a pro athlete doesn't work out. And so, I set my sights on being in sports marketing. And by the time I graduated from grad school, within a year I already worked for, in some capacity as an intern on a project for all four of the major sporting leagues, done a PGA Tour event; that was really living my dream. And by the time I was gosh, 26 years old, I was working for a national marketing firm, their sports marketing department and represented Mark McGwire the year he broke the home run record in 1998. I get to travel on a private jet with him to New York, took him on the David Letterman show, on the Today Show but it was actually on the private jet on the way back to California after a day and a half in New York with one of the most famous athletes in the world at the time, that I looked at my wife of three whole days because we got married on Saturday and we left Monday morning, she came on the trip with me. And I said to her, you know what, this has been amazing, I married the woman of my dreams a few days ago and I'm living my career dream. Everything seems to be going great, but I've got this pit in my stomach that I've had for a few days about, that I just need to do something different, and I want to do something different. That my dream of being in sports marketing no longer seem relevant now that I was married.

And it really was brought upon by the fact that my grandmother who I have been close to my whole life was sick, and right before my wedding she was there complaining that her wheelchair was broken and nobody would call her back to fix it and she requested a walker, and her benefits, her Medicare benefits wouldn’t pay for a walker. And at the time I was just a sports dude, I was 26, I didn't know anything about Medicare benefits but that's all I knew. This is this my grandmother, and I love her, and why her and grandpa work their whole lives, two jobs sometimes, why can't they afford based healthcare?

So, within a few months, one of my students at the university who I was teaching, came up to me and said hey, Dr. Luke, I've heard you talk about wanting a career change, I've heard you talk about your frustration with your grandmother's healthcare. There is an opening at my nursing home for a director of marketing and admissions. And the short version of that story Jay, is I took the job, got hired, asked them to train me to be a healthcare administrator. They entered me into their administrator and training program and I was a nursing home administrator for about four years before a small hospital in Southern California approached me about being their CEO. And before you go well that's a big leap, understand that it was a small aging hospital just trying to stay open. They had no debt, but more importantly they had two units that I had experience running. One was a nursing home under the hospital license and the other was a geropsychiatric unit for seniors who had psychiatric concerns, dementia or Alzheimer’s, and I was already working in the area knew those docs. So, I became a hospital CEO, did that for four years and then got hired to go across town and run another hospital in Anaheim for three years. So, that's really my whole story in two to three minutes or less.

Jay:
Yeah, well that is quite a story. It’s not a career path that you'll see many take. How about now, being on the speaking circuit? So, you go from being hospital CEO to now speaking all over the country and all over the world. How is it that you made that shift and can you talk about what your goals are?

Dr. Luke:
Yeah, I’ve really been blessed, Jay. You know God blessed me with a lot of diverse talents and I've always been comfortable speaking in front of an audience, even as early as high school, I had some success there. But what happened after the Affordable Care Act passed, is for the first time in my career, 10 years into being a CEO, all of these other executives respectfully had looked down their nose at me, had been like, how’d he get here, he's a nursing home guy, he didn't come up through the hospital ranks. And all of the sudden, after the Affordable Care Act, my phone started ringing from these same people: Hey, Josh oh buddy, can you tell me about this readmission thing, and you being a former nursing home administrator, you seem to know about it. And so, I wrote the first book on readmission prevention published by the American College of Healthcare Executives, and that is the one main trade organization for hospital executives: ache.org. They published it and it was their best seller in 2015. It was a new topic, it was controversial, it was contrary to how we get paid in healthcare, right?

You put a head in a bed, and we bill for it, and here's this new penalty that if you put that head back into bed too soon, we're actually you're not going to pay you, we’re going to take money back. People didn't like it. What happened Jay, is because I wrote this book and there was so much interest that people were calling me to come speak about it. I founded a website so thought leaders from across the country could contribute. I made it into a not for profit because vendors and solution providers were saying wow, there's so much energy around this readmission prevention collaborative. That website’s still there, it's a not for profit. It's three long words but you know them all, its: nationalreadmissionprevention.com. And it was just a way to get people together to talk about this new thing. But what happened is, I left my Vice President role at a health system in Southern California because this gained so much momentum, you know it ultimately came down to ‘I gotta pick one of these’ and I love speaking so much and I was literally the foremost operator in the country on readmissions.

The only other person that was getting the same request I was to talk about this was Dr. Coleman, who's a physician. And when he and I met and were appointed to the same two-day advisory panel, he and I took a liking to each other because we both were, I wouldn't say naysayers, but we were both pretty pessimistic about operationalizing some of the things we talked about because we've seen how difficult it was. So, he and I actually have spoken together I think more than 50 times in the four years since then. But that's really how I hit the speaker circuit. And what happened is I got so much attention and I was having so much success on the speaking circuit. I had people say, people just loved your storytelling, your humor, can you just become kind of our mainstream keynote speaker? And then when Forbes called to ask me to write a book for their books department, I actually made the decision to become a full-time keynote speaker.

And I can speak at any event you're having, whether it's for business, or church, or youth or trade, because my last two books are called Health-Wealth: Is Healthcare Bankrupting Your Business. So, if you're running a business and want to know how to reduce your costs, and then the new one that came out just this month February 2019; - Health-Wealth for You: 11 Steps to Save Big and Live Healthy. Both of those books are about engaging in the healthcare process, understanding that personalized and preventative medicine are the wave of the future, and that the millennial culture has not only brought technology, but they've brought ownership of your personal health. And so, within a few years, healthy living and healthy choices and engaging in the process is going to be the central focus of the healthcare conversation. Unlike the past where it was as long as I got a PPO, I'll go to the doctor in the hospital and my employer will pay for it. Folks, if you don't know it yet or not, that's not the case anymore, and you will be fully aware of that within two or three years because that high deductible plan is the result of the fact that Americans thought somebody else was paying for their care. 

Jay:
Well that's a perfect segue so, let's talk about the shift that's taking place in the healthcare industry and some of the change unfolding. What industry trends do you see emerging that will be game-changers for healthcare?

Dr. Luke:
Yeah, and I'm so glad that you invited me onto the show Jay because this is something that I wrote about in my prior book called Execute: A Former Hospital CEO Tells All and What's Wrong with American Healthcare. I really went after the big EMR companies and said, you know meaningful use, which passed in 2009 as part of one of the recovery packages and then was re-addressed in the Affordable Care Act in 2010. The central point of meaningful use and if you don't know that term, it just meant implement electronic medical records in hospitals and doctors’ offices as soon as possible. And it put penalties and benchmarks in there to do it.

There were two points, the tech ages arrived. Gosh darn it, hospitals and doctors, even if you don't want to do it, we're going to force you to use computers and document information. That was number one. Number two, patients have never owned their own health data and doggonit, it it's about time that a patient doesn't need to be so insulted when they go to a doctor or hospital and request their personal health information, to be told, ‘hey, it's going to take at least three days, you got to pay for the copying,’ and then they roll their eyes at you because you're making them do extra work. It's laughable that a patient doesn't own their own health data and that was the case even as recent as a year or two ago, until these regulations the government put in about implementation of electronic medical records. Now Jay, what I want to say is I have a huge frustration with meaningful use and the implementation of EMRs because never was the priority, from the hospitals or the big EMR companies. And by the way folks, if you're not keen to it, there's two or three that pretty much dominated 85 to 90% of the space.

And so, there's been a stifling of innovation on the hospital side because they had so much control, but there hasn't been any focus on getting the electronic medical record to you. And do you know what happened in 2018? It was a wonderful thing. Those two or three big EMR companies that had so much influence in the hospital sector; all the sudden they heard of a company named Apple, you may have heard of it, that said you know what, we're going to put the patient's record in their own hand. We partnered with 17 of the biggest health systems in the country, now 18, now 20, whatever it might be. And guys, here's the good news; - it's working. Patients are owning their own data, they're getting it in real time, they’re being able to access it, and the next step, which was already there, but again there was no drive to do it, was the cloud-based parallels, the term I use. My mother, bless her heart is in the final stages of Alzheimer’s disease, my dad cares for her, my wife and I go up and care for her, my brothers, we all pitch in, there's caregivers that go give her care. What I need for my mom isn't that once every two months she has an accident, ends up in the hospital, we know what happens there. I need to know, is she eating, is she drinking, did she have a fall, is she safe, is she communicating and that lives in the cloud. And I'm really excited Jay, that leaders like you, and Health Data Vision, and the Apples of the world and now, Amazon, and the cloud-based companies, and now big EMR, you know, and I'll say this, you don't have to; - it's being forced to the table to do the right thing, because of the pressure being put on them by Apple and the consumer. And that's the exciting part, the consumer went to Apple and the others and now big EMRs forced the table.

And Jay, I’m going to make an aggressive statement that I've made on LinkedIn before; - meaningful use could end up being the biggest waste of time and billions of dollars when we look back on it in 12 or 13 years. Because there's a chance that Apple and others are going to come in and swipe up those two or three big EMR companies and say, ‘Never mind that was a waste of time.’ It's never been about putting the record in the patients hand. Hospitals were doing the bare minimum they could to meet the requirements of the government, and to make sure they maximize their revenue, that was it. Until about a year ago.

Jay:
So how do you see that kind of push maybe from say, the Apple of the world, impacting the health plans in the providers? How do you see that changing the way they're operating today or the way they're thinking in their boardrooms?

Dr. Luke:
I think it's a huge wake up call. And I think right now it's kind of the, ‘well that could happen that would be, you know, that would be something that would really, you know, stir things up if it did.’ And then one day, just like couple of years ago with our presidential election, one day, everybody woke up and said, ‘oh my gosh, it happened, and we aren't prepared for it.’ And I think that's coming with Amazon and their new healthcare venture ABC with Amazon, Berkshire-Hathaway, JPMorgan Chase. They are going to start putting pressure on the big carriers. The Blue Cross', United’s, Cigna-Anthem’s of the world, to be a little more… Look I'm not here to say that things haven't been great. What I'm saying is they're starting to feel pressure because there really wasn't any, there was six players nationally. And as long as they're keeping their clients happy then really the consumers voice could go unheard because the client was ultimately the one writing the check. That's going to change. Amazon, Berkshire Hathaway, gosh even Apple, Microsoft, Tesla, Walmart; they are all saying ‘we can't afford healthcare anymore.’ And those are the best companies in the world. If they can't, who can? There's going to be a massive transformation of how healthcare is delivered over the next five to 10 years. I have no doubt about it.

Jay:
What do you see as the greatest barrier challenge affecting success in today's healthcare environment?

Dr. Luke:
I think the greatest barrier and challenges are the three largest lobbies for spending in Washington DC are pharmaceuticals, hospitals and physicians. And so, these are the reasons that every time there was something done in the name of the consumer that just wanted better care, access to better care, access to the records, that they were either stalled significantly by several years or just squashed all together.

The wakeup call we had that I referred to a few minutes ago was the hospital community since 2010. Just crossing their fingers that, gosh, you know, six years from 2010 when we have another presidential election, and there's no incumbent eligible, if we can get a Republican majority, maybe we can make this Affordable Care Act go away. But what folks realized is A, even Republican majority can’t make it go away but B, even with the Affordable Care Act going away, value-based care will never go away. And the reason is, American businesses can’t afford healthcare, American individuals can’t afford healthcare, and the Medicare fund is dry.

And the other point I would make Jay, is you can't go back to a system with no checks and balances like fee-for-service because doctors could order whatever they want without accountability, hospitals admitted everybody without accountability and there's no money left to pay for that. So, in the model of the future it needs to be focusing on keeping people healthy, and at home. And a lot of what the focus has been on in recent years, is going to go by the wayside.

You know, one of the reasons I love what Health Data Vision’s doing is because, nowadays it's all, reimbursements going to be attached to quality. And it's already attached to quality, and that's happening in increasing measures in hospitals for the first few years; I can say this being a CEO before hospitals during this era. It was such a minimal impact on the millions of dollars we collected every year that we really ignored it. We really ignored it until there was a Republican majority. And they took three swipes at the Affordable Care Act and couldn't undo it. And we realized that even if Obamacare went away, value-based care can't because there's no way to go back to a system with no checks and balances. And so, in ’18, 2017 and 18, you saw this mad dash by health systems to start transitioning and transforming to value-based care even though they didn't want to and they were forced to. 

Jay:
So, how do you hope that your speaking efforts and the following that's building behind you, on social media, that you’ve gotta support this ship, like what do you hope that's going to help accomplish? 

Dr. Luke:
Jay, that’s such a great question, thanks for asking it. And folks, you can learn about the different things that I support at drjoshluke.com. I'm active on Twitter @JoshLuke4Health the number ‘4’ health. And on LinkedIn, I post three or four times a day, almost every day, Monday through Friday, because I want to share with you the stories that I see that are relevant. And on LinkedIn, if you type my name in, make sure you type ‘Dr. Josh Luke’ because there's a couple other Josh Luke’s out there but if you type doctor, it comes right up.

But to answer your question directly Jay, there's two things that people appreciate me for both on social media when they hire me to speak. Number one, the Josh Luke that was willing as a hospital CEO to say ‘hey, I've read the Affordable Care Act, I’ve looked at the fact that the Medicare fund is dry and value-based care is imperative. There's no exception at this point, there's no money left in America to pay for this hyperinflation. We have to go towards a model that that incentivizes to keep people healthy and at home. Which means the golden age of hospitals putting heads in beds is over.’ So, there's really two personalities of Josh Luke that you can benefit from and one is that CEO that was bullying as early as 2011 to stand up and say, ‘here's what value-based care looks like and I'm going to lead the way.’ And that's partially because of my experience in posts to keep before I became a CEO. The new Josh Luke that was really kind of created and inspired by Forbes when they reached out to me to write a book. They said ‘hey, we have all these brokers and benefits advisors that can write this book on how American businesses can save money, but we love the fact that you're a hospital CEO who’s not tattling but just being transparent and pulling the curtain back on, on the middleman and the hospitals that aren't being transparent. So, can you write this book?’ And in turn they labeled me America's Healthcare Affordability Authority.

Now, I'm not an expert on the different benefits that mid-market companies and Fortune 500’s can implement. I know more than most. But what my job is to do Jay, is to shake the tree, to get businesses that shrug their shoulders every year at their second largest expense, which is healthcare benefits for their employees. After payroll, largest expense in almost every business is benefits. Yet every year, you get a call from your broker, ‘hey, let's go have a nice dinner.’ At the end of dinner, they hand you an envelope that says you're getting a 5 to 10% increase and ‘oh, by the way we're removing two of the benefit you had last year, because we can no longer afford to provide them to your employees.’ And people just shrug their shoulders and said, ‘man, this stinks.’ But it happens every year and next thing you know, it's 30, 40%, more than it was five or six years ago. So, there are solutions to stop that, there's the Health Rosetta, there's organizations like Fit and Health. There's so many different DNA testing microbiome of your stomach, there's so many things that you can learn about personalized and preventative medicine, and a lot of them are inherent in the millennial culture that when you follow me on LinkedIn or Twitter or visit drjoshluke.com or listen to either of my podcasts, you're going to find out that I'm really not there to sell you anything but to talk about transparency and transformation.

Jay:
That's great, thanks for sharing that. If you don't mind, let's take a closer look at how each level of healthcare should consider some of the oncoming changes. In a briefing with a health plan C-suite, what advice might you provide them for navigating our industry during these rapidly changing times? 

Dr. Luke:
Well I think that's a great question. You know, my advice to the hospital is this: value-based care is coming. And I was sitting with a major academic medical center in California a few months ago with their C-suite and they said, ‘hey man, we know it's coming but man we're not doing any of it until we're forced to.’ And that really is the poster child for hospital CEOs from 2010 to 2016. Times have been wonderful for years. Why would we change until forced to? And there weren’t a lot of regulations, even in the ACA and even in the Trump administration that have forced value-based care but, there's been an accumulation of penalties that have started to add up. That if you aren't transitioning, they're going to take back anywhere from, you know, 3 to 20% of your Medicare dollars which starts to add up. And a lot of the commercial payers and Medicare Advantage companies follow suit, because when the federal government does something, they see that as hall pass for them to do it.

But what I would tell you is this, Jay. I sat with that hospital, who I have great respect for, and I said, hey, if they're at 10% or less because even though they say they're not doing anything and people show up to their hospital that might be part of an ACO or, or some sort of Medicare Advantage plan. Even though they aren’t willingly going out and taking risks, if they're at less than 10% and the federal government stats show that more than 60% of Medicare claims in 2018 were through an alternative payment model, then that means the good guys. The guys doing things right, the guys that have said value-based care is inevitable. That means they're closer to 80 or 90%, if not 100%, does it not? Because if certain folks haven't even started; look, Jay, the hospitals I ran were safety net hospitals for the most part. They served the neediest of the needy, they were in the inner city. That was my passion to serve seniors and minorities and others that didn't have access or knowledge, education to understand how to get access to the best care. 

And so, if those hospitals haven't done anything just because they don’t have the resources to, and the national number is at 60% plus, that means that the good hospitals have basically said we're making a full commitment to this, and we're going to do it and they're already there. So, my answer would be different based on how they answered the first question. Where are you in your journey to value-based care and what is your commitment to it? Those are the two questions I'd start with. 

Jay:
That’s great. What regulation changes would you like to see for CMS that would most positively impact the members? 

Dr. Luke:
I'd like to see; first of all, I think Seema Verma's doing a fantastic job, she's President Trump's appointee. She came from the state of Indiana, where she had a history of saying, ‘sure, you can have free healthcare, you can have Medicaid in Indiana. But we also want you to, to put out an effort to do it, to not abuse the system and just show up to the emergency room without ever consulting a doctor.’ So, I've always had great respect for Seema. And in the minimum conversation I've had with her, I've been inspired but I see the things she's doing as great things. I talked to a lot of medical directors regionally that report to her and get input so that's how I stay in tune.

But what I would like to see may not even come out of CMS, so much as another department of the federal government, which is to question the not for profit status of hospitals, to question the community benefit. Is it truly a benefit? Because having sat in that seat with four different hospitals, it's just fuzzy math with hospitals, quite frankly. There's a lot of, ‘oh we get billions of dollars in charity care.’ Because 20 minutes into explaining how we got to that number there's not a person in the room that isn't an actuary that understands it. And the actuaries gonna say, ‘no, you're wrong, you're manipulating the numbers’ because they're smarter than us anyway, right? So, the point being, they've always gotten away with not paying taxes by claiming they're giving all this free care in the ED. But again, you can put any price tag you want on it. I would like to see hospitals no longer be not for profit ventures because ultimately when you transition fully into integrated care, which is a Kaiser Permanente model, where it's a true insurance company where everyone is rewarded for keeping people healthy and at home and out of the hospital, and the hospital becomes the largest expense in the model. And Jay, that's contrary to how we operate in the last 50 years and the fee for service era.

Jay:
That's great. Dr. Luke, how about one final question in this topic; - what recommendations would you have for the public, regarding their empowerment and ownership of their own health?

Dr. Luke:
Well, I think that's a great question. That's really the heart of who Forbes asked me to become America's Health Care Affordability Authority. If you follow me on social, I talk a lot about becoming an EHC, an Engaged Healthcare Consumer. When you shop for a house, you shop don't you? You shop neighborhoods, school district, number of rooms, things like that. When you shop for a car, you shop price, features, all those things. Why not for health care? And the answer to your question, Jay, is the reason that a lot of listeners, a lot of Americans now have a high deductible plan. They think it's a good plan until they actually have to use it, then they go, ‘This is awful. What happened to the good old days where my employer to pay for it?’

The reason you've been forced into a high deductible plan is because you were misled to believe, just as I was as a Gen-Xer, that the your insurance will pay for it. Now your insurance didn’t pay for it. They paid the claim that month. And then at the end of the year, when the HR director got taken to that nice dinner and handed the envelope, the cost was passed back on to you, your employer, who ultimately passed it back on to you as an increase as their employee. So, what you see is, nobody was ever paying for it for you. All you were doing was guaranteeing that you're going to have to pay more the following year. When, if you would had engaged in the process you could have seen, ‘Hey, if I would have gone to the ‘hospital A’ instead of ‘hospital B,’ the big shiny one everybody thinks is better, it would have saved my company 40 or $50,000, it  would have saved me a couple thousand dollars, and it wouldn't be more expensive next year. And by the way, the big shiny hospital, a lot of times, isn't any better if you research it. And the same doctor will operate on you at ‘hospital A’ that will operate on you at the big shiny hospital. And by the way, sometimes it is the big shiny hospital that is the center of excellence so nothing against bigger, shinier hospitals, just comparing. Don't assume something's a Cadillac because it's bigger and shinier. And that's the modern-day era of healthcare delivery in America. As a consumer, you must engage, as an employer you must engage, otherwise costs are going to continue to skyrocket.

Jay:
Dr. Luke, you've been a great guest for us today. And clearly one of the preeminent thought leaders right now in healthcare and helping members and individuals think about how to take more control over their own healthcare journey. Why don't we bring the podcast to a close with my rapid-fire round? So, we're going to run through five questions, no right or wrong, just kind of top of mind. What comes up when first hear the question. What keeps you up at night? 

Dr. Luke:
What keeps me up at night is just being able to figure out how I can take these gifts that I've been blessed with as a hospital CEO and as a writer and a social media influencer and speaker and deliver value to American individuals and businesses about how to bring the cost back down, where healthcare is affordable for basic access. And the staff that drives that is more than 50% of the millennial’s lifetime earnings, at present projection, will go to healthcare. 

Jay:
Yeah, that's a tough number to consume. When restless at night, what book might you grab from your nightstand? And it can't be one of your most recent books.

Dr. Luke:
Yes, I'll tell you the two books I share with my students. I teach at the University of Southern California in Healthcare Policy, and I share with my students when they asked us about generic books that changed me, there's two books that really shaped me. Believe it or not, in 10 years of university and 3 degrees, I never had one business class.

So, I read two books, after grad school that really helped me and one was called The Millionaire Next Door. And I found that that book really helped me understand that the richest guy in my neighborhood is the one you usually complain about, because they don't keep their yard up as well and they're driving an older car but it's because they know how to manage their money and not keep up with the Joneses. And then many of you have heard about a book series called Rich Dad, Poor Dad and I haven't read any of the Rich Dad, Poor Dad books, other than the original which talked about being an entrepreneur. And how, while most Americans are raised to get a college degree and go work for somebody, and call it a good job. The truth of the matter is, you're not truly free until you work for yourself. And that book did a really good job of reiterating that over and over to the point that you were almost angry that you hadn't been more entrepreneurial. And I found that I did benefit from working in corporate America for many years and it's made me a better entrepreneur, but it took me several years after reading that book to use the knowledge I learned from those two books to prepare to become an entrepreneur and a successful one at that.

Jay:
Oh, those are two great books. If you could redo one decision in your life, what would it be and why?

Dr. Luke:
You know that's a tough one. I always, I looked at my wife and I got married, she was younger than me but I was 25, I think I was 26 and she was 20, and I sit there, what are you going to miss out on by getting married young? And she said, I don't know what are you going to miss out on? I said well I never got to go to Europe or travel the world because I was so in a hurry to get done with my college education. So, for those of you who have kids are in high school or college. I don't want my kids graduate from college in four years. Unless, except for the money part, right? I want them to experience life. I think we're in a rush to get kids to grow up. And I remember having my master's degree in my hand at age 23 and going well gosh, this is everything I wanted and I look around at my friends and they're all like sophomores or juniors in college, and I gotta go be an adult, while they could still play for a couple years. So, traveling the world a little and being young while you can be was my priority, and while I'm very proud that I got that stuff done at a young age and it certainly has paid off, I'm not in so much of a hurry to convince my kids that you got to be done in four years. I want them to live a little and enjoy life while they're doing the things they need to do to prepare for a good career.

Jay:
Yeah, great advice. Alright so now from a little bit lighter question. What's your favorite app on your mobile device?

Dr. Luke:
Well I think you know the answer this one Jay, but it's been LinkedIn for a couple years. It's the one I opened the most. And while LinkedIn is where I grew my following, you know, about 30,000 followers in just one year when I really started to engage. And guys, engagement is the key and I don't mean post a lot I mean, engage in other people's posts as well. It's a 50/50 balance. Carry on meaningful conversations, be willing to thank somebody when they disagree with you because that's what social media is about. It's about having a meaningful conversation. And now I've transitioned to understanding that Twitter is probably the number one news source in the world. I actually had a Twitter employee tell me that and I kind of laughed and then he explained to me, hey, I have somebody with a camera on site at every event that happens, anywhere in the world and I went, wow, it's tough to argue with that. But Twitter is no different. 50% you tweeting and 50% engaging with people to build an audience and I've seen significant growth there too. But frankly Jay, I’m still learning how to really use Twitter, I mean I think nobody would argue that I understand how to use LinkedIn as well as most. I was the keynote speaker at the Masters of LinkedIn Summit last year in Los Angeles. But what I learned there is, I'm all about growing a following of subscribers that want, they're hungry for my message. I'm not about getting 200 or 300 followers like thousand followers, excuse me, like some of those others had. I have a niche, I want people in my niche to follow me so I can bring value to them and I'm starting to learn how to do that on Twitter as well.

Jay:
That's great advice. How do you invest in yourself?

Dr. Luke:
Yeah, great, great question Jay. I think we all need to do that. I really invest in myself by when I go to speak somewhere, making sure I spend time with those in the room that are the experts that keep me sharp. I always tell people I'm perceived as an expert on a lot of things but I'm actually, I'm not. I’m an expert on knowing 10% of each topic I talk about and then being willing to refer them to a Jay Ackerman if they have more questions about tech-enabled services for you know, health plans and things like that. I say hey I know that just the guy you need to talk to so shoot me an email, I'll connect you with Jay.

And that's all I want to be, I want to be the tree shaker and I want to be the guy that that knows the Jay Ackerman’s, the CEOs of the best companies at what they do in healthcare, in reducing costs of healthcare. And so, spending time with you today and getting to know your company gives me just enough experience to know and speak in an educated manner and more often than not, speak more educated than the person I've talked to about what you do. But when it gets deeper and they want to know more, just develop that relationship to refer them over to you. So, that's been one of the most rewarding things and that's how I educate myself having been out of the C-suite for two or three years now, I don't desire to go back into the C-suite. In fact, that the opposite, I have no desire to do that. But the way I still stay sharp is when somebody hires me to speak. I make sure I spend time asking them questions after I'm done, about, hey what are you seeing in value-based care, where are you in your transition, what do you think about Apple, what do you think about Amazon, what do you think's going to happen to these two or three big EMR companies that were, you know, so slow to respond to anybody for the last seven or eight years and now are feeling the pressure from Apple, what do you see happening? Those, that's how I get better. 

Jay:
Great. Well hey thanks for participating in the rapid fire round to bring it to a close, I would like to encourage everybody who's listening to check out Dr. Luke's recent books. Two of them were number one selling books on Amazon: Health-Wealth: Healthcare Bankrupting Your Business published in 2018 as you mentioned by Forbes Books. And Execute: A Former Hospital CEO Tells All and What's Wrong with American Healthcare. What Every American Needs to Know that was published in 2016. And now to add his third book, a follow on to Health-Wealth, Health-Wealth for You. I enjoyed reading Health-Wealth, I'm looking forward to the most recent one, Health-Wealth for You. And Dr. Luke, thanks again for your openness. You’ve been a wonderful guest for us. This will bring our Value-Based Healthcare Podcast to a close. Please follow Reveleer on LinkedIn. You may also follow me on Twitter @AckermanJay.