In Engagement Strategy, Healthcare Transformation, Interoperability, Patient Experience, Productivity & Management

Senator William Frist, a former U.S. Senate Majority Leader and nationally recognized heart and lung transplant surgeon, has launched a new podcast called A Second Opinion. The podcast’s mission: rethinking American healthcare. We invited Sen. Frist to join Deanne Kasim, Senior Director of Federal Health Policy Strategy at Change Healthcare, to discuss healthcare innovation, policy, technology, leadership, medicine and, of course, the Senator’s new podcast. Here’s what they covered.

  • Why use a podcast to tackle America’s healthcare problems? (00:56)
  • The intersection of public policy, medicine, healthcare, innovation, and entrepreneurship (03:57)
  • Defining social determinants of health: what they are and why they’re important (07:24)
  • How the Nashville Health initiative determined the top three health issues for the city and how the community is tackling them (10:16)
  • The most comprehensive set of data on social determinants of health in the U.S. (14:58)
  • Four principles for improving health and wellbeing in a community (19:40)
  • Three policy issues Congress must address now (23:58)
  • The role of technology to address healthcare access and quality at the intersection of claims and clinical data (30:04)
  • Four issues that will play out in the 2020 presidential election (33:18)

Episode Resources

  1. Contact Deanne Kasim
  2. Contact Senator Bill Frist, M.D.
  3. A Second Opinion podcast
  4. Price Transparency in Healthcare
  5. Practical Innovation in Healthcare
  6. 2019 Consumer Insights Report
  7. 9th Annual Pulse Report
  8. Value-Based Care State-by-State Report
  9. Price Transparency is Coming for Payers, Providers, and Pharma. Are You Ready?
  10. New Thinking for Providers to Reduce Bad Debt by Improving the Patient Experience
  11. CommonWell Health Alliance Awards Change Healthcare Six-Year Contract to be the Provider of Clinical Interoperability Services
  12. Change Healthcare to Provide Free Healthcare Data Interoperability Services for all Americans on Amazon Web Services

Show Resources

Show Transcript

DEANNE KASIM: Hello and welcome to the Change Healthcare podcast. I’m Deanne KASIM, senior director of federal health policy strategy with Change Healthcare. With me today is Senator William Frist, a nationally recognized heart and lung transplant surgeon, former U.S. Senate majority leader, and founding partner of Frist Cressey Ventures. Senator Frist has just launched a new podcast called A Second Opinion, whose mission is to rethink American health. The show covers healthcare innovation, policy, technology, leadership, and medicine. You can find Senator Frist’s new podcast at asecondopinionpodcast.com. We’ve invited him today to talk about his new show and to get his take on several hot healthcare policy topics now in the news and on the American agenda. Senator Frist, we’re thrilled to have you on the healthcare podcast today with Change Healthcare.

SENATOR WILLIAM FRIST: Deanne, great to be with you today. I’m honored.

(00:56)

DEANNE: Thank you. So, please tell us about your new podcast show. With so many ways to reach people today, why did you decide to start a podcast?

SENATOR FRIST: Deanne it’s been fascinating for me to look over the years as to where people get their news. Especially in the healthcare and the general health arena. From my days in the United States Senate and the 12 years since I’ve been in the Senate, I’ve spent a huge amount of time talking to people, listening very carefully, sharing information with them. And I’ve done it in a very traditional way. Coming off the platform of being in the Senate, I had the opportunity to speak and speak a lot, as much as three to four times a week for many, many months, talking directly to audiences of 500 people or 50 people or 1,000 people. And I found that really useful. Plenary sessions of conventions all the way down to small town-hall meetings. But the reach really wasn’t quite what I wanted in sharing information that I had both access to and continued to learn from other people to share. And a second way was writing every three to four weeks, writing an article that was published using print media and putting it on social media and hoping it’ll go viral. And again, very effective both in my sitting down and studying issues, and listening and articulating in a concise way. And then as times have shifted to today, most people don’t read articles clearly as much as they did five years ago. And people don’t have the opportunity to go and don’t go as much to these large conventions. And therefore, I have really focused now in the last several months on my interviews and my learning from other people and by sharing through a podcast. And thus, asecondopinionpodcast.com is out there today. And so it really is using techniques and the opportunity to reach people with the narrative, with the storytelling, with the oral tradition surfacing, coupled with the fact that we do have a visual presentation for social media like YouTube and others where people want the visual and the oral. So it’s really giving people information at a level and at a platform that they use today that they simply did not use as much six months ago, a year ago, or two years ago.

(03:29)

DEANNE: And certainly, podcasts are incredibly portable whether you’re listening in your car, an airplane, the Washington DC subway system, that’s great.

SENATOR FRIST: And you can stop, and you can inventory them and you can go back and you can collect them. And the big improvement has been in this curation of podcasts today that is improving day-to-day where people can go to health, or social determinants of health, or cost of health, or quality of health in a short period of time and get the very latest.

(03:57)

DEANNE: When you look at asecondopinionpodcast.com, what do you mean when you refer to the nexus of policy, medicine, and innovation as the centerpiece for learning, how to improve American healthcare?

SENATOR FRIST: Well I think you really hit upon not the secret sauce, but the area in which we are unique when you look at a lot of the other podcasts out there, and that is we look at the intersection or the convergence of three big spheres where I really do, based on my experience, believe that answers can best be generated, found and executed. In large part because of my history the three spheres are public policy, and that includes government, federal government, state government, local government. That’s one sphere. The next big sphere is the field of health in healthcare. And they’re not the same. Healthcare is where so many people look for answers today in improving health and that’s just not where it is. Health is very different than healthcare. Healthcare might be Obamacare, Romneycare, universal health insurance, Medicare for all, who your doctor is, what your hospital is, all of which are important, but they are not a major determinant of the health and well-being of whoever’s listening to us right now and their family and their community. It’s important, but it’s not the most important. And to be able to integrate health and healthcare in science is that second big sphere. Remember, the first one was public policy. The second one is the medicine, science, health, and healthcare. And then the third sphere, and I picture these like a triangle, and right in the middle is our nexus or our convergence where our discussions are and what we pull out of people as individuals who we’re talking to is innovation, is entrepreneurship, is new ways of thinking about how to solve these problems. And we use words like disruption. It may be overused as a word. But it captures the dynamism, the creativity, the new ways of thinking coupled with policy, coupled with health. And it’s at that intersection, that nexus that I believe solutions will be found to a system, a health sector, a healthcare sector that is the best in the world which got huge gaps and huge inequalities, things that we can address by this more holistic thinking. And the podcast out there today, at least no one else that I could find addresses with each of the people that they’re talking to from those three perspectives pulling out of them new ways of thinking. And therefore, we say that we’re rethinking health. This whole idea of rethinking where health and healthcare are today. And let me just close by saying that those three spheres come from my having spent 20 years in the field of health and healthcare. I was a heart and lung transplant surgeon as someone involved in global health on the ground giving care. That’s sphere number two. Sphere number one, public policy, 12 years in the United States Senate where I, every day, woke up and thought about policy. And the third area for the last 12 years have spent it in private investment, venture capital, actually starting healthcare companies from scratch and taking them to scale. And so, I’m going to be drawing personally, although it’s not about me, it’s about the people I’m interviewing from that perspective which is very real health and healthcare and policy and innovation, creativity and innovation.

(07:24)

DEANNE: Excellent. Well I really like the way you’ve laid this out and Lord knows we could use more of this combination in the healthcare industry. So, thank you so much for explaining that. Hey, let’s dive into some of the issues that are really affecting today’s healthcare policy and innovation topics. Let’s start with healthcare data and social determinants of health. You know it seems like in policy circles, particularly affecting Medicaid populations, we’ve been talking about social determinants of health for almost a decade. But all of a sudden, the greater industry is looking at this and talking about it. From your perspective, how do you define social determinants of health and why is it so important?

SENATOR FRIST: I love the fact that you’re starting with that. First of all, social determinants of health, I don’t like, it’s not that I don’t like, but I think the words are overused a little bit. So I usually start off talking about the non-medical drivers of health. The non-medical determinants of health. And then start from scratch at that point. And then I normally go and my podcast it sort of evolves this way in explaining it that the healthcare that we think of, again the universal healthcare, the issues of doctors and hospitals and insurance account really only for about 15% of the impact of health as we know it today. And by health, I mean health and well-being and the productivity that comes from that. And so, if that’s 15%, where is the bulk of the impact drawn from? And we know environment’s probably 10%, and socioeconomic factors 15%, and genetics about 30%, but it leaves the fact that this 40% or the overwhelming impact compared to the doctors and hospitals is in this non-medical drivers. Then I move very quickly to what are they? They are the food that we eat every day. They are our environment in terms of where we live and how we live, and that includes housing itself. Another remarkable social determinant non-medical driver that people don’t come to early but is critically important is access to the internet. And I bring that up because people forget about it, yet when you look in our rural communities that may be the most important determinant of health in terms of getting virtual care and getting telemedicine today. So these non-medical drivers coming together, yes interacting in part with a doctor or a hospital or an insurance policy is ultimately where the health and well-being of a community, of a family, of an individual is determined.

(10:16)

DEANNE: Excellent. Thank you for describing all of that. I wanted to pivot because I know you’ve been so involved in your initiative, Nashville Health, and how that’s been part of a greater Healthy Nashville initiative. Can you tell me a little bit more about that?

SENATOR FRIST: Yes. And after spending 12 years in government addressing health in Washington, and 20 years delivering care with my own hands and taking care of thousands of patients, thousands and thousands of patients and then the 12 years of starting companies and that are solving many of these problems the government doesn’t solve and policy doesn’t solve and big companies don’t solve, I’ve come to the conclusion that one of the best ways we, and it includes our listeners now, can spend our time is looking in our own communities with their own individual needs that may be very different. Nashville is very different than in Austin, Texas, or in Atlanta or a Charlotte, or a Raleigh, Durham, North Carolina. To look inside and take a population and say how on average without leaving out anybody, how on average can we bring the health of that population, the health and wellbeing of that population up? Elevate it. Increase it as a community. And what it does, it causes people to look at their collective action, to look at their families, to look at their neighborhoods, to look at access to food, to look at policies around smoking, to look at obesity in a way that is very personal, that is very close, that is very intimate, that they care about. They care about their families. They care about their children. They care about the ecosystem around them. Thus, I have put together and again I say I, the community here has put together an entity called Nashville Health. It basically says there’s 700,000 people who live in our larger neighborhood of Davidson County, Nashville. Let’s come in and get a baseline of how healthy we are in terms of yes, how long we live and infant mortality, the sort of the classic measures of health. But also look at burden of disease. Look at that safety and security with our police department. Look at food deserts and identify, get a baseline first and then systematically say let’s prioritize what we need to work on. And in Nashville Health we said after talking to experts around the country and their evidence-based medicine, talked to local people to 110 town meetings and put those together and said there are three initiatives and let’s go after them and let’s measure them. Let’s get the baseline. We know that they will have a measurable impact based on evidence-based applications around the country, what we’ve learned. And they were number one, smoking. 22% of people smoke in Nashville. Unbelievable. A hot city. A cool city. Young people coming from all over the world and all over America to come and live here, yet 22% of people smoke here in Davidson County. That’s more than Austin, Raleigh, Durham, Charlotte, Dallas. It’s the number one killer here in Davidson County. It’s why infant mortality is as high as it is in large part and why overall survival is much lower than those other cities. Yet Nashville is a booming city with low unemployment today.

Number two, we took hypertension. We identified that again from the grassroots what Davidson County, the incidents here, what drives it coupled with evidence-based medicine and say we’ve got to improve especially in certain pockets of Nashville, the diagnosis of high blood pressure, the initial treatment and then keeping people on that treatment. And what we can do in the third area is child health and focusing on sleep and a whole range of child health issues. It has to be community-driven from below coupled with evidence-based medicine and science from around the country. You’ve got to have the buy-in from the philanthropic organizations. There are 110 in Nashville supporting the initiative. The hospital community, the healthcare community, the private business, the largest employers, and huge representation from the underserved communities, if you put those communities in a room, which we do with Nashville Health, you identify your priorities, you get a baseline of data which is very difficult to get but once you get it, you have that baseline and then measure it every step along the way. We are demonstrating that that can have a huge impact in raising the overall health and wellbeing of not just the average citizen, but especially those that are deeply underserved in our community today.

(14:58)

DEANNE: Excellent. When you mention that data, I noticed in doing some background research that there was a survey effort last fall between Nashville Health and the Metro Public Health Department. Can you tell me more about getting people to complete the survey? How did that go? What were some of the incentives? And I understand there’s some new data that’s going to be released from that survey this fall.

SENATOR FRIST: You know, so much of what we do today is not measured, and therefore you have nonprofit organizations and for-profit organizations, and private and the public sector in government doing all these things that are well intended. They look good on paper. They sound good. Money flows. But they’re not organized and aligned in such a way that synergies can be realized. And therefore, you walk away five years later and you say well that was good, but has it really improved health? Has it really improved well-being? And from our earlier discussion on social determinants, if you don’t know what the social determinants are, and then what resources are in a community, then no matter how much money you spend on doctors or universal care or healthcare, it’s not going to have an impact. And the beauty of a Nashville Health is it holistically looks at health and well-being. So not just the doctors and not just the hospitals, but these determinants that are out there, but where do you start? How do you know if you’re having an impact? It all comes back to data, to measurement, to knowing what the baseline is. And that’s hard to get and very few communities in America have done it. But because Nashville Health has allowed us to bring people together from the public sector, private sector, from the faith community especially, we undertook to get a survey across the board, a comprehensive survey, much better, much more comprehensive, much more inclusive than the very best government data out there. Much more. And what that takes is taking a population of 700,000 people, dividing it into eight different areas in order to be able to take it down to the geography, the area to capture the geopolitical impacts ultimately. And the survey’s called the Nashville Community Health and Wellbeing Survey. Broad participation, all gathered with private funding mainly, but also some public funding, getting current state-of-the-art techniques.

And as we all know from the last political elections, how you get data and how you do surveys is very important. Most surveys today are still done on hard-lined telephones, yet very few people today use that as a primary or even secondary mode of communication. So what we did is we went to and had the state-of-the-art tools and we got the people in America who are most on the forefront to put together the survey. The survey uses a combination of internet and paper and it combines this in a modeled way that it’s state-of-the-art that gives you the most accurate data possible. So right now, that’s government data for Davidson county, 700,000 people that’s based on modeled data. This is the government data, all the government data of about 400 interviews. What we’ve been able to do is go to the community and in a short period of time gather more than 2,000 interviews on more than 110 different parameters. Aggregating that data today. Putting it together. And within about two months from now it’ll be open sourced to the community, released with some initial findings and then allowing the very best to academic research, non-profit community organizations to open source this data to establish a baseline. And from that baseline, they can take projects, go to scale, and judge whether or not they’re working. Hugely exciting. A community effort. Huge community buy-in. State-of-the-art. And I would argue it’s the most current, best data in the United States of America right here through Nashville Health working very closely with our metro health department here in town.

(19:09)

DEANNE: That’s excellent. This certainly sounds like such an important success story on so many levels. Particularly the data as you mentioned, which really has to be the foundation for decisions and actions.

SENATOR FRIST: It’s the data and those analytics that come out of it. And again, to me the future, so much of healthcare and the excitement I have is, we live in a world today where people value the data, value the analytics, and know that many of the answers which were not available because the data wasn’t available in the past are available today.

(19:40)

DEANNE: Oh, I completely agree. And here at Change Healthcare we certainly know a lot about data and analytics. You know as you pointed out earlier, what goes on in Nashville in the community in Nashville’s certainly different than in Austin or Charlotte or even where I’m at in Washington DC. How would you offer maybe some pearls of wisdom or some common threads to other communities who are looking to do something similar to what Nashville is doing?

SENATOR FRIST: Thank you. Nashville Health is on the cutting edge in large part because of our collection of data, use of data. But several things in terms of pearls of wisdom but things that we’re learning that we share right now with people around the country. Number one, the most important thing is not built for just the heart surgeon or the local hospitals, but the most important thing for a community’s health and well-being is establishing a culture of health. That health today is determined in large part by where and how you live and work and play and pray. And it’s a culture that we must establish and therefore if you use social media, use our workplace, use our nonprofit organizations to continue to emphasize using the appropriate language that a culture of health is more important than any individual policy out there or any individual piece of legislation. Number two, that policy does matter. And you know in this day and time with this extreme partisanship that characterizes Washington DC, it’s not so much characterized in our local communities and the policies are what set the large framework or the train tracks or the foundation from which we’re going to establish this culture of health. So I encourage people to pay attention to policy. And it may be as simple as smoking policy around schools or at the workplace. It may be policies allowing federal legislation and Washington DC to participate, engage in that particular policy. And number three, I think it’s incumbent upon each of us, whether an entity, an institution, or an individual, to look at the economics of health and of impact of what we do and what we can do through policy, through a focusing on these non-medical determinants as well as better organizing the medical determinants. The economic impact, I don’t start with it because I’m a doctor, and I start with the patient and I start with well-being and making their life better and more fulfilling and getting rid of disease. But we can’t run away from this third factor of talking about the economics of improving people’s productivity. Of raising the overall economic sort of viability and vitality in a community is very much focused on health and well-being and whether people show up for work. Or whether they can adequately take care of their children if they have some sort of chronic disease and they need to be able to get help and access that help. Of lost days from work, or what we call absenteeism, of the burden that falls on our Medicaid system today by not including preventative care or including reimbursement for food if that’s an important social determinant or some reflection on housing. Look at these economics because you can see the real impact. When you look at economics you can bring people to the table that you otherwise couldn’t. And then fourth, bring everybody to the table. This is too complex. It requires comprehensive solutions. Everybody aligned around certain things. So put together representatives from the disease entities, from the vulnerable populations, from the housing community. Get their voice. And so those are sort of the four big principles and buckets that we’ve learned and that we continue to learn from as we move forward establishing what ultimately with that number one principle is a true culture of health which will bring that back greater life, productivity, and wellbeing to people throughout communities.

(23:58)

DEANNE: Excellent. Thank you so much for sharing those recommendations and those observations of the good work that’s going on with Nashville Health. That’s a good segue into our next topic talking about policy right now between the House and the Senate. There’s a lot of discussion, a lot of legislation talking about price and cost transparency as well as surprise or balance billing. This really sort of falls into those two buckets is transparency and then of course the surprise or balanced billing. They definitely go hand in hand. I’m willing to bet that every listener in our audience has been subjected to a surprise bill, a balance bill, or some other charge that they were not expecting in healthcare whether it was in or out of network. If you look at the spirit of where the legislation is going this year, it definitely is talking about meaningful transparency and the administration is talking about that as well between initiatives and RFI’s that came out between ONC and CMS this year. When we look specifically at the Senate HELP package that Senator Lamar Alexander has been working on so diligently, and for our listeners, that stands for the health education labor and pension committee. Specifically, we’re talking about senate bill 1895. The Lower Healthcare Costs Act of 2019. There are so many things in this package including issues talking about drug pricing, how out-of-network surprise bills are going to be handled, and additional public health initiatives. Senator, what do you see as some of the more meaningful solutions that the industry could look to do for surprise billing and really bringing more meaningful transparency on cost and quality to the consumers and patients?

SENATOR FRIST: Well I think you’re really taking the conversation right to where the American people are. You know, yesterday it was very much about access purely looking at access and that’s where Obamacare, which has really a lot of great things in it, but a lot of things that have been very difficult and the sort of unwinding of that could be pointed to for all sorts of reasons. But in part it was this lack of focus on cost which is where the voters out there are thinking today. With high deductibles that has quadrupled in the last six years, with increasing co-insurance, this burden on the individual today is being felt. I’m talking about everybody in America feels this cost of the healthcare today. So that’s where the focus is. That’s where the focus is going to be on the elections. It’s where the American people are. Access is important, but I can’t even think about access when the biggest barrier is cost and it’s what’s driving me into bankruptcy and making it so I can’t really help my children in other ways. So I think that’s the shift. The immediate focus as you said is very much on the bill and the help committee. Senators Alexander and Murray have introduced this bipartisan bill and this focus on ending surprise billing is part of the answer and an important one to address, but it’s really more of a marker, the fact that people are so mad that there’s no cost transparency, no spending transparency. They’re forced to pay for something and they don’t know what they’re paying for because of the lack of transparency and they don’t know how much did it cost. So the surprise billing clearly is one that actually will be taken on, as everybody as you mentioned in your set up to the question. Everybody feels it. The things they have in there are requiring insurance to pay a regional benchmark rate for out-of-network providers. So when a patient sees a doctor who isn’t in their network, insurance would pay them what right now they’re calling a medium in-network rate. It’s controversial in certain areas because the provider community says that’s not fair given the way the system works today. But I’ll tell you from a consumer standpoint, we all have our stories. The gag clause isn’t, and again this is a little bit technical in the weeds but it’s important to people to know why this legislation, why policy matters. And it’s why in our podcast, A Second Opinion, we talk a lot about it because policy is there. There are these gag clauses and anti-competitive terms that are written into the insurance contracts that specifically prevent employers who are buying most of this insurance, and the patients who are paying for it from knowing cost information and quality information. The whole value equation to the consumer, which is what matters, is this relationship between outcomes or quality, which is in the numerator of the equation. And then in the denominator or the lower part of it is cost per dollar that is put into it. So the fact that there are these gag clauses that are there. And then in the drug world, again it’s a whole different world and I know we don’t have time to go into that, not only the transparency but right now the cost of drugs and many of the pharmaceutical companies have obviously done this to maximize profits for their shareholders, there’s this whole lack of drug competition. Right now, the generic and the biosimilar drugs there are clauses in the legislation to increase that competition so that prices will come down. So as you get further into the specific legislation and it’ll match with legislation coming out of the Senate, these are the three big areas. The surprise billing, the elimination of gag clauses, anti-competitive terms, and increasing generic and biosimilar competition. President Trump, it looks like, will continue every few weeks putting out something on price transparency because it is such a popular issue to executive order. But I think the big thing, all of this comes back to the consumer or the patient or you or me and our listeners having no idea in a world of markets of knowing what things cost and yet they’re buying the most intimate thing to them and that is some element of their health and healthcare.

(30:04)

DEANNE: I completely agree. What do you think the role of IT can be in terms of getting more meaningful information to patients? So, for instance, right now with CMS’s blue button there’s a very valiant effort to try to free up, tell the Medicare payers, for instance, Medicaid payers, to give that data to consumers. That’s part of the equation, right? That’s part of what the claims data says. And then there’s the whole clinical component of what do things really cost? Where do you see perhaps a happy medium between technology and all this information and really what’s meaningful to the average patient? Particularly really appreciate your opinion on this because you are a physician and have that perspective.

SENATOR FRIST: Every talk I get and paper I write or in the podcast you’ll hear an element of excitement, of optimism, of looking ahead, recognizing for the first time in history the cause of data and the exchange of that data and the analysis of that data because of technology, because of parallel computing and super-computing and the advances that are made with the shortening of the half-life of information, obtaining information we, for the first time, have in our grasp, the tools to address healthcare access and quality and measurement of quality and the issues you mentioned, the surrounding cost and spending and the difference between spending and cost. And so this aggregation of data, this collection of data, I guess it’s tough right now for these few years as we’re fighting issues of privacy and depersonalization and taking any kind of identification off the data. But the fact that in that data, and the claims data we’ve had for a while. But the clinical data has never been really integrated with the claims data in a way that is useful from a practical standpoint. And that to me is where the action is. It’s where the answers are. It is the ideal example of what A Second Opinion, our podcast, does is take the policy and marry it with the health and outcomes and healthcare of individuals and marrying it with the creativity and the innovation and all of that comes from data. It’s an awareness. It’s an integrating factor. It’s an understanding of the ecosystem that traditionally we did not have today. And again, they are great, great companies and obviously, Change is on the forefront of that, is pulling this data together in a way that is secure for the individual, for the patients, but collectively is for the wellbeing of an individual and their family, of a community, of a state, and of a country. And that’s why I’m so excited today because for the first time we’re going to be able to develop solutions to these historically insurmountable problems and challenges out there surrounding the cost of healthcare and the quality of healthcare and the financing of healthcare today.

(33:18)

DEANNE: Thank you Senator. I could not agree more with you about the power of data and IT solutions to make that happen. Pivoting to our final topic, let’s look at what might be the number one topic today and most likely through the 2020 presidential election. What is your view on the best path forward for the US healthcare system? And when you think about the many approaches that are being discussed right now early on the campaign trail, there’s fixing the ACA and adding a public option, there’s Medicare for all, Medicare for some, Medicare buy-in, what do you see as really the best path forward to really fix the US healthcare system and build a sustainable system for the future?

SENATOR FRIST: Well it’s a huge question. It’s one that is more than aspirational in large part because we have these new tools provided by data and analytics that weren’t there. Now as a physician for 20 years practicing every day, my entire focus and I’m speaking on behalf of nurses and caregivers out there today, but my entire focus was on the individual who came through that door or in that bed to take them and let them in the policy arena through health and through healthcare. In the policy arena you look at aggregate of policy because it’s fairly blunt, at least at the federal level. But at the end of the day it’s to try to improve that individual’s understanding of the healthcare system, but most through the healthcare system to make it more seamless, more comfortable. And on the innovative side, we got to develop these tools to do that. On the political side and the 2020 elections, I’m encouraging each of the candidates that I talk to to focus on the same thing that I did as a physician and that is that individual and what is convenient for that individual, what is affordable for that individual? And so I increasingly think we’ll start with these big structures, for example, Medicare for all and the Democratic primaries. It is clearly, deeply now for the first time in a presidential election the words Medicare for all are deeply embedded in the political narrative for 2020 and probably for the next five or 10 years beyond. Now we go to that second layer which will play out in the next several months, what does Medicare for all mean? We have Bernie Sanders’ plan, who has a totally government administered single-payer system eliminating all private health insurance. And obviously that’s the most expensive of the proposals—$30 trillion dollars probably over 10 years. And then you have Joe Biden using the words Medicare for all and it’s really sort of Medicare for all lite approach where, as you mentioned, you’d have an optional Medicare buy-in on the Obamacare exchanges that are out there. So we’ll need a better understanding by the American people of what political figures are saying. But what’s driving all of that comes back to the individual, to affordability, to convenience for that individual. So I see these big trends of moving towards a more consumer-based system instead of one driven by the providers as one that will play into the elections. I think the second big trend will be recognition of those people who understand the holistic social determinants, non-medical drivers of healthcare. They’ll be increasing popularity there, I think, among the voters themselves as they float through. A universal government one size fits all system will be argued by the extreme, but from a practical standpoint there is absolutely no way from a legislative standpoint so for people it’ll be aspirational. Ultimately all of this was going to feed into a system that combines 50% government and 50% market drivers, private forces, how do you cut the huge 30% of waste that is overuse, too many procedures, too much health given to underuse, not enough prevention out there, not enough people taking care of themselves. Let’s say that we have to incentivize that and educate people to the misuse of healthcare, overuse, underuse, and misuse. And that’s what I see playing out in the election. So two things. Focus on cost, convenience, affordability for the patient. And number two, how do you get rid of this 30% waste in healthcare today?

(37:53)

DEANNE: Yeah. That’s definitely huge. The 30% waste in healthcare, which needs to be addressed, I think, more creatively and more succinctly on the policy front. Any thoughts on the state front? Some of the states have looked at Medicaid buy-in in terms of their state Medicaid plans.

SENATOR FRIST: Again, this is an exciting area. People who were for Obamacare or say oh gosh we’re just blowing up and then people who were against it cheering but not really putting anything new on the table. All of this is a reflection of the fact that we don’t know what will work. And what we do know is that what will work for some people may not work for other people; therefore we shouldn’t try to take a one-size fits all solution when we’ve got 350 million people who are very different in very different communities and very different regions of the country. It’s not going to work. So what’s happened is the real reform and the experimentation that may be not a good word to use, but the innovation, the creativity, is at the state level. So you’ve got 50 states plus the District of Columbia thinking, trying. They know it’s their responsibility to address how to get this 30% waste out and improving the health and wellbeing. So we had these huge crucibles of experimentation that again, I look at very optimistically because out of that, if three states figure it out and it works there, it may be that we can apply it or the states can adopt that coming in. So this whole idea of experimentation with the states and reaching out with different types of programs. And some may go for the equivalent of a Medicaid for all. Allow the Medicaid buy-in. Some may go back to the Obamacare approach of strict Medicaid expansion with the federal government paying for most of it. Some may have a much more voucher individualistic approach. I represented a state here in Tennessee where I am today that has three grand divisions and those three divisions from a healthcare standpoint are very different in their expectations, in their needs, even within a state. So this increased experimentation, trying new things, measure them, seeing what works state by state is something that I support. And again, gives me great energy in an optimistic way as I look to the future.

(40:16)

DEANNE: Great. Thank you for that. Any thoughts on the current ACA lawsuit where that might end up?

SENATOR FRIST: No. You know I follow it just as most people do, reading what comes out. I think the most likely thing is that the overall Obamacare will not be overturned. That there will be some piecing off and there will be the severability that a lot of people right now say it’s not separable but I think that it is very unlikely that Obamacare in its entirety would be overturned. Again, I cannot predict and I’m not willing to look into a crystal ball even if you tell me it’s okay to eat crushed glass later to do just that, but if I did have to predict I would say the ultimate impact will be yes, part of Obamacare is off the table forever, it’s overturned, but that some of the very important parts, and obviously think of pre-existing illness as one of those, will be severed from that final.

(41:19)

DEANNE: Yeah. So I think there’s components that are too popular and too important to the American people. One is definitely the pre-existing conditions and two is dependents until 26 staying on their parents insurance.

SENATOR FRIST: Hugely popular.

(41:32)

DEANNE: Agreed. Well thank you Senator Frist for joining us today on the Change Healthcare podcast and good luck with your new podcast.

SENATOR FRIST: Well thank you. It’s going to be exactly this sort of discussion so I really appreciate the chance to be with you and it’s asecondopinionpodcast.com, appreciate people coming on. You can sign up anywhere as you know wherever you get your podcast today. But I appreciate it. It’s very much in this vein of looking at these very complex issues out there in a way that operates at that nexus of policy, health, and innovation.

(42:04)

DEANNE: Well great. I look forward to it and I really appreciate your time. Thank you so much.

SENATOR FRIST: Thank you.

DEANNE: Thanks again for joining us today on the Change Healthcare podcast. This is Deanne KASIM, policy and advocacy leader for Change Healthcare. We’ll see you next time on the Change Healthcare podcast.

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