Tuning Healthcare, Episode 13: The Evolution of the Value-Based Payment Model

Dana Safran, Senior Vice President, Value Based Care & Population Health at WELL Health

This episode of Tuning Healthcare features Dana Safran, Senior Vice President, Value Based Care & Population Health at WELL Health. She formerly held leadership roles at Haven and Blue Cross Blue Shield of Massachusetts and served in advisory roles to numerous local, national and international organizations and government agencies. Dana shares key insights from her broad value-based care experiences, and where she expects the industry to move in the future.

“I think I was interested in the field of public health before I actually knew that there was a field of public health. And for some of your younger listeners, that that may seem hard to believe, because I think for young people today, there’s such a great awareness of public health. Especially in this time of the pandemic. But, in the 1980s when I was in college, public health was a kind of stodgy field that was concerned about sanitation, and it wasn’t the multidisciplinary, or at least not known as the multidisciplinary human rights and social good field that I think it is now. But I somehow always knew that my interest was in the intersection of data and analytics and decision-making.”
– Dana Safran, Senior Vice President, Value Based Care & Population Health at WELL Health and former executive at Haven and Blue Cross Blue Shield of Massachusetts

In this episode, Dana and Lumeris Senior Vice President Nigel Ohrenstein discuss:

• The creation of the Alternative Quality Contract as a breakthrough payment model
• The significance of expanded quality outcome and patient experience measures for successful value-based contracts
• Essential elements providers need to be successful in value-based arrangements
• Key factors prolonging the dependence on fee for service payment models
• How the Biden administration can help solve critical issues facing the healthcare industry through public/private partnerships.

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• Read Transcript Below:

  Nigel Ohrenstein: In this episode of Tuning Healthcare, I’m joined by Dana Gelb Safran, who is the senior vice president of value-based care and population health at Well Health. Dana is widely regarded as one of the architects of value-based care, when she designed and launched the Alternative Quality Contract, the AQC, at Blue Cross Blue Shield of Massachusetts. Most recently, Dana was head of measurement, insurance markets and benefit redesign at Haven, the healthcare venture of Amazon, Berkshire Hathaway and JP Morgan Chase. In this episode of Tuning Healthcare, Dana and I discuss the intersection of data and analytics in decision making. She gives her insights on the AQC and the importance of measurement in value-based care contracts. She outlines what providers need to do to be successful in value-based care, and we discuss what the Biden administration could do to speed up the transformation of the U.S. healthcare system.

  Nigel Ohrenstein: Join Dana and me as we tune healthcare.

  Nigel Ohrenstein: All right. Dana, thank you so much for joining me today. It’s an honor to have you with us. I feel like there’s so many topics we could cover, but why don’t we begin, if you would, by sharing a little bit about your early life, what inspired you to go into healthcare? Are there any seminal moments as you look back and say, “This is why I’m doing the job I’m doing today”?

  Dana Safran: Oh, that’s a deep question. And thank you, Nigel. It’s an honor for me to be here and have the chance to have this conversation with you and share it with your listeners. So background on me, I think I was interested in the field of public health before I actually knew that there was a field of public health. And for some of your younger listeners, that that may seem hard to believe, because I think for young people today, there’s such a great awareness of public health. Especially in this time of the pandemic. But, in the 1980s when I was in college, public health was a kind of stodgy field that was concerned about sanitation, and it wasn’t the multidisciplinary, or at least not known as the multidisciplinary human rights and social good field that I think it is now. But, I somehow always knew that my interest was in the intersection of data and analytics and decision-making.

  Dana Safran: I had done some interesting work in my college years on environmental issues around trying to inform policy during a semester away from college, and really learned from that the importance of policymakers really having good data and analytics and information, and how much they needed that from reliable sources that that could be seen as unbiased. From college, I went to work at a now defunct research arm of the government called the office of technology assessment. It was a formative time, because I really through that, came to understand how exciting it was to take science and put it in front of decision makers to try to make the quality of decisions better, and also came to really understand that the field of public health was where I wanted to make my career.

  Nigel Ohrenstein: Obviously, you’ve had an amazing career. What do you look back on and gives you the most pride?

  Dana Safran: Oh well, I think what I’ll always feel extremely proud of is the work that I was able to be part of while I was at Blue Cross Blue Shield of Massachusetts. I went to Blue Cross at the end of 2006 on the invitation of Andrew Dreyfus, who is now the CEO, has been for many years, but at the time had a different role in the company. Andrew knew that measurement was getting to be really an essential set of capabilities for health plans, provider performance measurement, and that he wanted to have somebody in the company who not only was expert in measurement, but really was expert at engaging the provider community in the value of that measurement, the integrity of the measurement, and really cared about the integrity. So, it was an incredible privilege and a leap of faith for me, going from 16 years in academia to this very important role in a business.

  Dana Safran: I think if I had truly understood how different the role was that I was moving to and the skills that I would need to be successful at it, I might’ve been far more intimidated and maybe even been afraid to take the leap. But there I went. Within a few months of my arriving, our then CEO of Blue Cross asked for us to begin to develop a new model of payment for providers. I was fortunate to be among a small handful asked to sequester for 10 days to come up with this new model of payment. The idea was it should be voluntary, so only provider organizations who shared our vision that we could do better in healthcare would come into this model, and it should do two important things. It should improve quality and outcomes while slowing spending growth. Those two minor things that are really the holy grail, and that now we know as the triple aim, but I guess we were lumpers, not splitters, so we called that our twin goals. What we came up with was the alternative-

  Nigel Ohrenstein: We split it one more time. We made ours the triple aim plus one. But anyway, that’s a separate conversation. We were four splitters.

  Dana Safran: So what we came up with was the Alternative Quality Contract or AQC. We often joked that had we known the AQC would become so well-known and influential, we would have sent it to our marketing department before starting to talk about it outside the building. But in any case, being part of both the development of the AQC and then the management of its success was really one of the high points of my career to date, and something I feel very, very proud of. It catalyzed payment reform in the country, helped spawn Medicare ACO movement and payment reform and Medicare and private sector. That was not just because the model itself is so good, though it is, but also because we had the foresight to create a collaboration with Michael [Chernew 00:12:17] and his team at Harvard medical school to study what we were doing in a rigorous way while we were doing it. So all the while, even in the first year, there were publications showing that we were in fact improving quality and outcomes and slowing the rate of cost growth. I think that peer reviewed evidence-base is why the AQC has been so influential.

  Nigel Ohrenstein: Yeah. To say that the AQC is well-known is a little bit of an understatement. It is, to those of us in value-based care, it’s almost seen as the first major step. It’s almost the founding father, if you like, of value-based care in a real way. It’s a truly amazing accomplishment that obviously you should be very proud of.

  Nigel Ohrenstein: One of the things that I find fascinating is obviously those of us that have spent so much time looking at researching different models of value-based care and what works and what doesn’t work, one of the things that I thought was fascinating, and correct me if I’m wrong perhaps, there’s definitely a scale, the first time that I think it was done, was where you really combined to have responsibility for total cost of care, where you didn’t separate out physicians versus facilities versus, right? And you said you have to have responsibility for total cost of care. I mean, I don’t know how many times we’ve had physicians that say, “Well, can you carve out drugs?”

  Nigel Ohrenstein: And I’m like, “Carve-out drugs? Do you know how much of an impact that has on the health care of your patients? Where they simply just take their drugs or not?” And so, it seems to me that you started that. People who had theorized about it, but you put it into practice, which is a whole different ball game, as we know. Theory to execution is night and day. Tell us, what was the brainchild for of crossing that chasm?

  Dana Safran: Well, I would say Nigel, that we can’t take credit for the idea of global budgets, but what we maybe can … because, the 1990s of course, had been filled, and maybe we could say littered, with examples of what then we freely called capitation. That name rarely gets used anymore because it has such bad associations with it, but that was in effect global budget contracting. There were many methodological flaws, I think, of the capitated models and the ways that they were executed at that time, but one of the biggest pieces that was lacking and that the AQC added, and where I think we were really novel, was that by 2000, the early 2000s, when we were doing this, the field of quality measurement had advanced sufficiently that we could create a robust set of quality outcome and patient experience measures that were a very effective way to serve as a backstop against any impulse to stint on care that might arise from a global budget.

  Dana Safran: That counterbalance I think, was very, very important. We had, in our earliest contracts, which launched in 2009, 64 measures that covered ambulatory and hospital care, and within each of those settings covered process of care, outcomes, and patient experience. And a very, very significant earning opportunity on that set of quality measures. Because of that, I think that really was one of the real differentiators of the AQC. The other thing I’ll say that probably was a differentiator, is all different ways, as we now know, to set that budget, to set benchmarks against that budget, and one of the things that we did that I think was very important and influential in both the early adoption by providers who were willing to come into the model, but then the success, was to say that that budget is based on the historic spending for the population that is attributed to that provider.

  Dana Safran: The reason that’s so important is there have been so many things written to say up to a third of what we spend on healthcare isn’t providing value, could be considered waste. So, we could have easily taken that budget and said, “Here’s the budget, and we’ll take 2% off,” just 2%, not a third. “2% off as your starting budget”. But what we knew was, number one, if we did that, we’d probably still be waiting today for the first providers who were willing to sign up. But second, there would be enormous public mistrust, because I think we have to reckon with the fact that in the U.S., we do still have a culture that, for the most part, believes more is better when it comes to health care. Maybe that’s changing. Maybe the pandemic is going to contribute to it changing. But fundamentally, I think most people fear getting too little care, not getting too much.

  Dana Safran: A model where patients might know that the budget was set lower than, and that a provider system had less to work with financially than they had previously, I think would’ve made people nervous. So those two things, having a really robust set of quality outcome and patient experience measures, and setting budgets at an amount that everybody understood had waste in it, and then saying, “You’re accountable to help find that waste and remove it, and you will share in the savings if you do. And if you overspend that budget, you will share in the deficits”, I think were some of the differentiators of what we did.

  Nigel Ohrenstein: Yeah. Let’s talk about measurement of value-based contracts, because clearly an area where you’ve given a lot of thought. To me, that was the pioneering thing in many ways of AQC. Because as you said, obviously we had global budgets, and people had lost their shirts on it, but it was that balance I think, that you managed to strike. What are some of the fundamental … So for those people that are thinking about getting into value-based contracts, have a small percentage today of their lives in value-based agreements, but are still predominantly a fee for service operation. What are some of the fundamentals that you think are critical in a fair, balanced value-based care contract?

  Dana Safran: Ah, in the contract. I thought you were going to go somewhere else. I thought you were going to say, “What should those provider systems feel are the critical things they need to do to be successful in the contract?”

  Dana Safran: So sure.

  Nigel Ohrenstein: You can answer that as well. Sure, take both.

  Dana Safran: Yeah. I’ll start with what do providers really need. What we saw as markers of success were, I think, four different strategies that providers used and had to attend to, to be successful in the model. I’m using the word providers to refer to organizations. For individuals, I refer to them as clinicians. So, when I’m saying providers, I mean an entity. I mean an organization. And recognizing that we had both physician-based ACOs in the Alternative Quality Contract and hospital-based, we had both. If we get time, we can talk a little bit about the observations, ours, and then those in the literature, about differences there. But I really saw four things that organizations did to be successful.

  Dana Safran: One was, they understood that they needed new staffing models to be successful. We saw provider organizations bringing in social workers much more in the way of nursing and care management staff, bringing in pharmacists onto the team, and really building out a team approach to care that allowed for them to do what global budget contracts demand that is truly different from fee for service contracts. And that is to think about and care for the patient when they’re not in front of you. That is just a fundamental difference that when you’re being paid based on the totality of care and outcomes, as opposed to the units of service for the person who’s in front of you, then you have to begin to think about that human being when they’re not in front of you. What the challenges and barriers are to their being able to manage a chronic condition, avoid the onset of a chronic condition and so forth. So new staffing models were one really essential ingredient. Paired with that, were new models of engaging patients. Those two things, I think were really critical.

  Dana Safran: Then there was recognition that uses of data and information systems were absolutely essential to success in these models. You had to really be looking at your population, understanding both the population level and the individual level of how you were performing. One of the things that I think was another differentiator of the AQC that we haven’t spoken about was our support model, and where we work directly with provider organizations that came in to give them data and analytics, provide insights about where were the opportunities for savings, where were the opportunities to improve quality and outcomes? The data and data management part of of success, I think really can’t be overstated.

  Dana Safran: And then finally these organizations had to pay more attention to the intersection between and among providers, whether within their system or outside of their system. Because, again, this is one of the differences when you’re now accountable for the patient regardless of where they are, not just for the encounter, then you really have to be thinking about the ways that your patients in your population might fall through the cracks, and you have to try to create some infrastructure so there aren’t such cracks. That’s a profound difference to care delivery that really requires attention to be successful in these kinds of contracts.

  Nigel Ohrenstein: So, 15 odd years later, we’re still struggling. Why is that? I mean, to you and me it seems so straightforward, right? The things you need to do, the value, we can put any number of examples in front of physicians, health systems, payers, that show that quality is better, efficiency is better, it’s better costs. If anything, we’ve improved quality, not sacrificed it, but yet we still struggle, and the fee for service system remains like a drug that we can’t get out of. Why do you think that is, and how do we change it?

  Dana Safran: Yeah, I think I’ll point to three factors. I’ll point to payment and incentives, I’ll point to data and information, and then culture. On payment and incentives, the reality is that even with the progress that we’ve made on a very large share of provider organizations having some number of accountability contracts, that still a very large share of revenue is coming from fee for service. In particular, because we’ve seen the kind of shifts in the way healthcare is organized, where now, I don’t remember the numbers off the top of my head, but a very, very large share of physicians and especially specialists are now part of hospital systems. Hospitals really begin to be, and multi-hospital organizations, begin to be the center of healthcare delivery and organization. These payment models, even though they have created accountability for total cost of care, haven’t fundamentally changed the incentives for hospital systems.

  Dana Safran: When you are a primary care physician group, there is a lot that you can do that’s downstream from you, to manage total cost of care, that helps you win in a model that’s managing total cost of care, without hurting your own revenue in any way. But, when you are the hospital system, so much of the revenue that is sustaining your organization really comes from the delivery of those expensive, complex episodes of care, that the idea of cost sharing isn’t really sufficient to overcome the loss of revenue that comes from doing fewer things. As I was transitioning out from Blue Cross, one of the things that we were beginning to experiment with was new payment models for hospitals. And, in Maryland, there’s the global budget model for hospitals, and you could think of what we were doing as global budget models for physician organizations, even though it included hospital, long-term care, the whole of it.

  Dana Safran: I really felt that, if you bring these two together, and actually fundamentally change the way hospitals are paid and have a budget constraint, then you might actually begin work away at what still remain to be incentives that are largely fee for service driven for some parts of the delivery system. So, payment and incentives, I think is one reason that we haven’t made more progress.

  Dana Safran: A second reason that we haven’t made more progress is data and the information that we have. What I mean there is, we still fundamentally have a measure set as a country that is very, very process oriented. Our quality measures grew out of a generation of wanting to measure quality and having fee for service payment. So, we measured things that were done. We measured the extent to which the things that were done were in line with what guidelines would tell us should be done. That leads to, number one, a huge outcry that we hear from providers who say there’s too many measures. Because, if you’re going to measure everything that’s getting done, and if you’re now accountable for the total cost of care and everything that gets done, boy, that’s a lot to measure. Whereas, if we’re measuring the outcomes of that care, what we called in some work I was involved with for the Healthcare Payment Learning and Action Network or the LAN, big dot measures, the big dot measures. You’re measuring the outcomes.

  Dana Safran: Now you can actually be parsimonious with your measurement. But unfortunately, even though there has been consensus for quite a long time now that we need to move toward more outcomes oriented measures to pair them with our value based payment, we’re still very early in that, and very much reliant still on process measures. And I would say, the lack of visibility into the outcomes that we’re creating in healthcare is part of what holds us back from actually fully realizing the potential of value-based payment, because neither can we hold accountability for outcomes because we don’t have the appropriate measures, nor can we afford providers managed to those outcomes because we don’t have the measures. So that’s, I think, a real second challenge.

  Dana Safran: And then the third is cultural. When you start to incentivize and measure new things, it fundamentally changes the job of the human beings who are responsible for healthcare. If you or I were told that we were going to still do our same job, but be measured in very different ways, we would have to think about how to do our job differently to achieve those. And that’s hard. That kind of change in first of all, just the mental change to believe that what you were doing or how you were doing it before needs changing is something that many human beings will rightly resist. And then, the actual ability to change it and not just as an individual, but as a whole team, as a whole organization, is not a trivial undertaking. So, just those trivial three things, how we pay for care, how we measure it and, and our culture around how we do our jobs, I think make it very hard. But I am optimistic that we will get there.

  Nigel Ohrenstein: Yeah, I’m optimistic too. At least what we’re seeing in the market is that the phrase I’ve used before, which is the healthcare industry was recession proof, but not pandemic proof. The reaction that we’re seeing from a number of health systems is that actually I need to speed up my move to value based agreements, because that will protect me better as we move forward into the next iteration of what health care looks like. I’d love to touch briefly on your time at Haven. Haven is … when you went to Haven, perhaps the most sought-after job in healthcare. To go to work on everything that was going on there. Tell us a little bit about that experience, and what you did at Haven.

  Dana Safran: Yeah, sure. Before Haven was announced, I had begun thinking about the fact that I wanted my next chapter after Blue Cross to be something on the purchaser side of the table. That was because I had grown enormously frustrated with the fact that purchasers represent a very, very large share of healthcare spending, and yet in my experience, were not having influence on the demand for value that was proportional to that level of spending. I felt really compelled to sit on the purchaser side of the table and help demand more value out of the system. But, I knew I couldn’t do that working with one purchaser, or two. So, I was in search of what is a good platform from which to do this work? Then Haven got announced, and it was clear. That seemed like it was the thing.

  Dana Safran: So. it was a thrilling venture. I started in January of 2019. I think I was employee hire number nine for Haven. The energy and the excitement over what was in front of us was really thrilling. I like to say that I hadn’t worked in startups since I had been in academia, but in a lot of ways, starting your own academic lab is being in a startup. So, the intensity from that perspective felt familiar. I walked in the door at Haven with the job of head of measurement. Then, within the first week also acquired the job of leading our work on insurance markets and benefit redesign.

  Dana Safran: I think some of the most meaningful experiences I had while I was at Haven were the experiences of being out on the road back when we could still travel and do so freely, meeting with the employees of these three founding organizations, Amazon, JP Morgan Chase, and Berkshire Hathaway, and talking with frontline workers about what their pain points are in healthcare. Almost inevitably, what it would come down to when we asked the biggest pain points, had to do with cost, but not just that costs are high, but that costs are so unpredictable. What we were working on at the time, and this is one of the few Haven initiatives that is out in the public, publicly known, so it’s all right for me to share that we were doing this, was some benefit redesign work to say, “How can we help in an era where health plans, or at least commercial health plans are largely high deductible plans where employees find it incredibly difficult to know what their costs will be? How can we actually make benefits easier to understand and use?”

  Dana Safran: By being out there, talking with employees and understanding what their experiences were, it really helped inform that work. And now, each of the organizations is underway with some of that benefit redesign work, and with my measurement hat on, I was in the process of evaluating what the results were. We’ll see when a little more time goes by. Of course, COVID has been a major confounder in the opportunity to evaluate new benefit designs, because the ways people are using care changed radically, and not just because they had a different set of financial incentives in front of them.

  Dana Safran: It was a tremendously exciting place to be, and a marvelous, marvelous team to be doing the work with. I really got the bug for the startup world. Being in an environment where there’s so much energy and you’re trying to do something new, and you know it’s hard and you need to prove it, in a lot of ways, that was like my academic days, and I loved that. So, that’s why I find myself now in another startup where I began last month, leading the work at Well Health Inc on value-based care and population health.

  Nigel Ohrenstein: Yeah. That sounds incredibly exciting. Tell us a little bit about the mission at Well Health.

  Dana Safran: Yeah. Well is a five-year-old company, and it’s a communications solution company. Really the vision of our founder and CEO, whose name is Guillaume de Zwirek, is to make healthcare the number one consumer experience of all industries. So you might say that’s an audacious goal, and I would agree. It comes out of Guille’s own experiences with the healthcare system, which he describes regularly when he talks about his motivation for founding this company. But as a very young man, which he still is, he had a serious health issue, and really had to be up close and personal with the healthcare system, and found it to be, despite wonderful doctors and wonderful hospitals, as he says, just a terrible experience because of fragmentation and difficulties. So Well Health seeks to be that last mile communication platform for providers and patients, and now in the work that I’m doing, also between health plans and patients, and ACOs and patients, because Nigel, you and I both know, there are so many organizations right now doing some really wonderful innovation to try to get to better outcomes, get to more affordable care. One of the biggest impediments is actually reaching the patient. Actually getting to engage the patient, motivate the patient and help continue to support the patient.

  Dana Safran: So a tool that is enabling all that wonderful innovation to be more successful is really something I feel very proud to be part of. And, I think, back to our earlier part of this conversation, will be one of the things to help make ACOs more successful. That’s part of why I’m so excited to be part of the Well leadership team, is that I do think that by helping to enable success with the patient engagement, we will help ACOs be more successful, and therefore help payment reform be more sustainable and scalable. That’s something I continue to care passionately about.

  Nigel Ohrenstein: The number of organizations that are in health care now trying to help figure out a part of the solution is absolutely stunning. I’m with you, I hope that, obviously hope Well is successful and from a global healthcare, U.S. healthcare perspective, hope that so many of these organizations help us solve some of these problems that you identified, which are not easy to solve, as you so well-articulated.

  Nigel Ohrenstein: We’re about to transition to a Biden administration. Given your background in public policy, what would you like to see from a new administration that would help solve some of these problems? If you have always felt that some of the best solutions come from public/private partnership, what would you like to see from a new administration to help solve some of these problems that we continue to face in healthcare?

  Dana Safran: Well, I’d say number one would be a firm commitment to the strong implementation of the ACA and the continued implementation of the ACA. To have over 20 million Americans who have coverage who didn’t have it before, is no small success, and we need to really be sure that we don’t lose that. We also need to recognize that the ACA has not solved the cost problem, and like the model that the ACA drew from, which was Massachusetts coverage reform, in Massachusetts, the reason I didn’t share this when I was talking about the AQC, but the reason the AQC was born was we knew that our coverage reform law in Massachusetts would do great things to get to universal coverage, but that now we had to solve the cost issue, after that.

  Dana Safran: So, the ACA really did take us a good distance with starting payment reform, as we’ve been talking about over this hour, but we have so much more to do. I’d like to see the Biden administration doubling down on the efforts around payment reform. I’d like to see some greater parsimony in the number of payment models that are out there, so that we can truly be learning what’s working, so that we can send stronger signals to the provider organizations that we are in fact progressing away from fee for service, but that it’s not a dizzying array of different models and choose the flavor you like, but that there is a systematic way that we’re going to progress from fee for service system to a system that requires accountability for the total cost of care for populations.

  Dana Safran: Those two things, I think are critical. And then, I’d name two more. One is the infrastructure for measurement really has to improve. That second piece I talked about with respect to the barriers to making more progress on payment reform is our data and information. In order to move toward more value-based care, we have to have a better set of measures around outcomes. And to have that set of measures around outcomes, we have to have better data capture. So, public/private partnerships around the data capture and around the really accelerated development and validation of big dot outcomes-based measures that can help us to manage for results, not just deliver services in healthcare, is critical.

  Dana Safran: And then the final piece I would say is that the pandemic has really shown us that we have to think more broadly about public health, and in that I’ll include social determinants of health. We can’t continue on thinking that the healthcare delivery system and the public health sector are separate things that work in parallel. They have to work in conjunction with one another, so really developing policies and practices that enable that, I think is another important priority for the Biden administration.

  Nigel Ohrenstein: Yeah. I couldn’t agree with you more. The lesson if you like, the many lessons obviously, from the pandemic, but the separation of health from public health to what you want to call commercial health, for want of a better word, is clearly shown to have failings as we’ve experienced the last year.

  Nigel Ohrenstein: One quick topic I have to hit on before we wrap here, is I was reading your Well Health bio, and there were two things that stuck out to me. The first is a passion for adventures. What does that mean, a passion for adventures?

  Dana Safran: Sorry, I was just letting my next meeting know that I’m running a few minutes late, and that they should start. A passion for adventures. I love travel. I have, since I was young, really been somebody who likes to be experiencing new things on a very regular basis. I never liked, and still don’t like, to go back someplace on vacation that I’ve been before. I like to just keep experiencing new places. And of course, you can’t, at least at the stage of life that I’m at, be traveling all the time, I do earn a living as well. So, how do I have adventure on my day-to-day life? Spending as much time as I can outdoors. My husband and I love cycling. We love taking long cycling trips on the weekends. I’m somebody who has always … the worse the weather, the more I love to be outside. So, running and cycling and hiking, being outside with my dog, who is always a good excuse, even during COVID, or maybe especially during COVID, for being out in the woods. That’s what I mean.

  Nigel Ohrenstein: And the other thing that stuck out on your bio was mixology. So, if we were to post-COVID, be invited round for a cocktail party, what would be the drink of choice that we should expect?

  Dana Safran: Oh goodness. Well, I think it would depend on the time of year really. Having just come through Thanksgiving, we were into apple cider mules, so things that have some apple, some spice, and mules. But, we change it up. Actually one of our favorite restaurants in our town where we took lessons from a phenomenal bartender, has been one of the casualties of COVID, so we’re really very sad about that, but he has been a good teacher and equipped us with infinite, really infinite variations on cocktails by giving us a recipe book and then how to mix it up, to mix metaphors there.

  Dana Safran: Yeah, we do enjoy being creative with the cocktails.

  Nigel Ohrenstein: Yeah. It’s so hard not to miss the human side of this past year. Whether it be people’s health or people’s businesses. It’s really incredibly tough. So, I’d like to end with what I call the quick fire round. Just your quick thoughts on a couple questions. Best piece of advice you were ever given?

  Dana Safran: Give credit to others. Yeah.

  Nigel Ohrenstein: That’s a good one. I think it was Nelson Mandela who said, “Lead from the front, but let other people believe you’re leading from the back,” or something similar. I probably butchered the quote a little bit, but something very similar. What do you do to relax, have fun? I think we’ve covered that, right? Being outside?

  Dana Safran: Yeah, but because I probably gave you too much detail on that other one, I’ll say it short and sweet here, so you can use it. Just love to be outside, love to be on my bicycle, be in the woods, hiking, cycling, traveling when that’s possible. That’s fun. And now, actually really love cooking.

  Nigel Ohrenstein: And if you could change one thing about healthcare, what would it be?

  Dana Safran: We’d be managing toward results and outcomes. We’d have great measures of outcomes and be paying based on value and outcomes, not based on individual units of service.

  Nigel Ohrenstein: Dana, thank you so much for joining me today. There’s so many things, as I think back over this conversation that you’ve said that are insightful, but if there’s one quote that really sticks with me, it’s to think about and care for a patient when they’re not in front of you. If that is one thing that we can take away as healthcare executives as something to ensure that we’re further ahead on next year than we are this year, that will make 2021 a successful year. My best wishes to you and your family for the holidays and thank you so much for joining us today.

  Nigel Ohrenstein: Thank you for joining us today. Please follow us on your favorite streamer, and don’t forget to rate us, as it helps others find our podcast. As we approach the holidays, I wish you and your family a happy and healthy holidays and a successful 2021. Please join us next time as we tune healthcare. This is Nigel Ohrenstein in New York.