Tuning Healthcare, Episode 14: Driving Outcomes from the Intersection of Health and Data

Dr. Ashwini Zenooz, Chief Medical Officer and SVP for Healthcare and Life Sciences at Salesforce

This episode of Tuning Healthcare features Dr. Ashwini Zenooz, Chief Medical Officer and SVP for Healthcare and Life Sciences at Salesforce. Dr. Zenooz was most recently the Chief Medical Officer at the Department of Veterans Affairs (VA) overseeing the national EHR modernization program. She is board certified in radiology and continues to practice medicine today. Dr. Zenooz provides unique perspective from her clinical and healthcare policy experience and shares insight into digital health innovation.

“And then my mother got sick and I became a caregiver and I saw her go through the process of being a patient in this country. And I had worked at some of the best institutions in this country, and I really was flabbergasted at how broken our system is. I don’t think I’d ever seen it or thought about it from the other side, from what a patient has to experience, not only from the healthcare delivery side, but working with insurance companies, getting the thousands of pages of notice of benefits explanations that, to me, it was like gobbledygook. I was like, “I don’t understand what this is saying. And if I don’t understand what it’s saying, how is somebody who’s a lay person supposed to understand this?”
– Dr. Ashwini Zenooz, Chief Medical Officer and SVP for Healthcare and Life Sciences at Salesforce

In this episode, Dr. Zenooz and Lumeris Senior Vice President Nigel Ohrenstein discuss: 

• Gaps in care coordination and the patient experience
• The need for more consumerism throughout the care delivery process
• The impact of technology on COVID-19 vaccine distribution and the current lack of tools in the public health sector
• The significance of venture capital investment in digital health and potential post-pandemic beneficiaries
• The importance of maintaining a “kitchen cabinet”

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• Read Transcript Below:

  Nigel Ohrenstein: I’m joined today by Dr. Ash Zenooz, the chief medical officer and GM for healthcare and life sciences at Salesforce.com. Prior to that, Ash was the chief medical officer at the Department of Veterans Affairs, overseeing the national EHR Modernization program. Ash is board certified in radiology and continues to practice medicine today.

  Nigel Ohrenstein: In this episode of Tuning Healthcare, Ash and I discuss what an incredible time it is to be in healthcare, as we are at the forefront of the digital transformation. That this is the time for interoperability and how we will see an ecosystem of APIs, the importance of focusing on the patient, and the opportunity to improve the customer experience in healthcare. And finally, the need for a personal kitchen cabinet. Join Ash and me as we tune healthcare.

  Nigel Ohrenstein: Ash, thank you so much for joining me today. It’s a real privilege for us to chat to you. I feel like there’s so many topics that we could cover over the course of this podcast, but I’d love to begin with just a little bit about background. How did you get into medicine, why radiology, and sort of how did you get your start?

  Ash Zenooz: Well, Nigel, thanks so much for having me, first of all. I have probably wanted to be a physician for as long as I can remember. My grandfather was the concierge physician in our town who rode around on his bicycle seeing patients. And so we have a long history. His father was the town physician, I have come from a family of physicians. So I think I probably didn’t know anything else, and I was so fascinated. My father is a veterinarian. So just really interested all my life in medicine.

  Ash Zenooz: And when I got into it, there are really a couple of things. I loved the diagnosis of things, and I like to put things together, and it’s like a puzzle piece, and I like procedures. And so there are only a couple of things where that would all come together. And for me, that was radiology. Radiology is a place where you really take all of the history, look at the different pieces of the puzzle in an image, tie it all together in a nice package, if you’re good at it, that is.

  Ash Zenooz: And then if you’re an interventionist, or you do interventional procedures, you actually get to see patients and you get to have that continuity of relationship. And so for me that was the perfect balance. And so I’ve enjoyed being a radiologist and practicing medicine.

  Nigel Ohrenstein: That’s great. And what was the impetus to go to the Hill? To sort of move out of sort of, I mean, you still practice, but to move out to sort of everyday practice and to try and impact healthcare on such a much grander level, right? The scale of impact that you could have in the Hill, obviously at the VA, and at Salesforce is much greater. So what was the impetus for making that change?

  Ash Zenooz: Yeah. I think I would say I just sort of fell upon it initially. When I moved out to Palo Alto, I had the opportunity to serve as a subject matter expert on one of the house committee briefings and started visiting the Hill. And for many years after that, I would attend as a subject matter expert and spent a lot more time on the Hill. And I thought that was fabulous. But I really love still practicing, so I never saw that as something I would go do.

  Ash Zenooz: And then my mother got sick and I became a caregiver and I saw her go through the process of being a patient in this country. And I had worked at some of the best institutions in this country, and I really was flabbergasted at how broken our system is. I don’t think I’d ever seen it or thought about it from the other side, from what a patient has to experience, not only from the healthcare delivery side, but working with insurance companies, getting the thousands of pages of notice of benefits explanations that, to me, it was like gobbledygook. I was like, “I don’t understand what this is saying. And if I don’t understand what it’s saying, how is somebody who’s a lay person supposed to understand this?

  Ash Zenooz: And then really end of life, like working with the pharma companies for her end of life potential treatments. I think it just opened my eyes to the parts of healthcare I just didn’t pay attention to, even though I had so much, I was steeped in it. So at some point, I think I just decided, “I’m going to have a bigger voice and I’m going to speak based on my experiences, both as a clinician and as a caregiver on behalf of my mom who did not have a voice, and carry that forward.” And I think that was my transition to the Hill.

  Nigel Ohrenstein: Right. That’s incredible. And for any of us who have experienced a family member in hospital, you sort of really understand how important it is to play that coordination of care role. And as you correctly say, there’s so many parts of the healthcare system, for those of us that are involved in it every day, that it’s still incredibly difficult for us to navigate. You then think about someone who doesn’t know the healthcare system, or doesn’t have the medical background and knowledge that you have, it’s frightening. And so it’s obviously part of what Lumeris has spent a lot of time thinking about, and I’m sure you have as well, the whole basis of coordination of care and how can we do that more effectively.

  Ash Zenooz: Yeah, absolutely. And I think I would go in and hesitate to say things at times because I had a relationship as a physician with a lot of the other caring providers in the system. And others in my family who are not clinicians, were worried about asking something because they weren’t sure it was relevant. So I think it’s from both sides. Everybody benefits when you ask the questions, everybody benefits when you have access to information, and you can spend the time asking questions, spend the time getting the information, and there’s an appropriate coordination of care to your point, right? Those are all really important pieces that somehow, at least at that time, we had just missed, I think, as relevant to healthcare. And we were working in 15-minute blocks seeing patients, and it’s just not the right way to do things.

  Nigel Ohrenstein: So, let’s fast forward to Tack and Salesforce.com, which is obviously a titan in the industry, and a brand that’s known across the world, but not necessarily a brand that’s known for healthcare. So tell us a little bit about your role as the chief medical officer of Salesforce, the GM of the Healthcare & Life Sciences division. What does that mean? What does success in your role look like?

  Ash Zenooz: Yeah. I was really attracted to Salesforce when I got here two and a half years ago, because I think I just saw the relevance of this relationship platform that other industries were utilizing. And I saw how it would be really beneficial to really the healthcare industry, helping connect all the dots. So I was attracted to come here, and what I learned when I started looking at Salesforce is that they’re not new to healthcare. Salesforce has been around for 20 plus years, 21 years, and the company has been working with healthcare and life sciences customers just as long.

  Ash Zenooz: They started off as a sales platform. So that’s how they sold into various life sciences customers initially. And then they grew into the service and then the marketing and broadened to integration. And then when they bought Tableau, when we I guess bought Tableau, it was really bringing all of that data and insights into a single place.

  Ash Zenooz: But as you and I both know, healthcare is high in regulation and in complexity. So at some point, about four or five years ago, we decided that it was important to go deeper, to build more specific capabilities for these customers that we had and the ones that were coming on to Salesforce. So that’s when we started an industry focused vertical and made a lot of sense to recruit folks like me. And so that’s the makeup of my team, folks that have been in clinical, have operational expertise, that have worked in life sciences, R&D, understand what happens from molecule to market, and how to bring all of these technology capabilities and translate them, not only to understand what the customer is asking for, to sort of be the translator for the customer, but to make sure those translations mean that you’re actually building products that make sense for those customers. So that’s what my team and I do.

  Ash Zenooz: And last year I took on, last year or a little bit before that, I don’t exactly remember, but I also took on the additional hat of chief medical officer, which I will tell you, it has been incredibly challenging given that the pandemic soon followed. And I hope I’ve been useful to the company as a result, but really what that means is everything that I was doing for healthcare that my team and I were working on now became relevant to everybody else. Initially it started in the public sector where we started working with governments, trying to build solutions during the pandemic to help scale responses. And sometime during the course of last year, every company became a healthcare company.

  Ash Zenooz: So we started interfacing across all the other types of companies that were thinking about having their employees back at work, or employees that were at work, how do we keep them safe? How do we manage this contact tracing? How do we understand that somebody is getting tested and is negative? How do we have that command center to … Do we need an emergency response management center where we account for PPE and the number of masks and gloves that we have? The apply to grocers, meat manufacturers, airline industry, I mean, you call it, we were talking to them.

  Ash Zenooz: And so that’s been really incredible over this last year, understanding what other industries are thinking about. And then also thinking back to our own employees, how do we keep them safe? Initially, it was how do you keep them safe physically thinking about returning to work, but the pandemic has taken a toll on the mental health of people. So ensuring that we are providing the right type of benefits and thinking through these things for our employees, my team and I have been really important part of all of these conversations. So that’s the makeup of my role. It’s a little bit of this and a little bit of that.

  Nigel Ohrenstein: And so it’s fair to say that Salesforce views its role as how do we build products and services to enable sort of the existing healthcare players to be more successful in delivering high quality, efficient healthcare. As opposed to some of the other Silicon Valley companies who seem to have more of a desire to disintermediate the system in some ways. Is that a fair assessment of how Salesforce views their role in healthcare?

  Ash Zenooz: Yeah, absolutely. I think we see ourselves, to your point, as an accelerator or a tool to help empower our customers to do their jobs more efficiently and to deliver more personalized care for their customers, whether they’re patients or members or whatever form the individuals take. So, yeah, we are not in the business of direct healthcare delivery. We are not in the business of providing insurance, et cetera, but we are building tools. What I say to most people is the way you know that we’re working really well is that you never know that we are in there, right? So we should be the engine in the background that is bringing all these disparate sources of data to a single place so that the contact center agent, or the care manager, or somebody who’s working in a research lab, has all of that information at their fingertips and can have real time collaboration. But I don’t think it matters if they know that it comes from Salesforce. It means we’re doing our job if it’s working well.

  Nigel Ohrenstein: Right. And we’ve discussed this before on this podcast, and many people have discussed it elsewhere. There’s so much runway for healthcare organizations to learn how to treat a patient as a customer. We are so far behind, I mean, just basic stuff like what food you like, just the type of stuff that if you show up to any type of industry that does customer service exceptionally well, we’re so far behind, and there’s so much runway. I’ve said this before, I’ve written about it, and we’ve spoken about it before, that the health system that really and truly figures out customer service is going to run away with market share in their industry. And there’s a belief that they have it, like everyone will tell you, “We’ve got patient-centric care, patient-centered medical home,” right? Whichever model you want to put to it, but everyone will tell you that patient-centric care. And we know that for, when we started talking about your mum, anyone who’s had an experience knows we have physician-centric care, right?

  Ash Zenooz: Yeah, absolutely. I mean, when you look at all these other industries and how far they’ve advanced, every industry has learned that focusing on your customer, being customer obsessed, which usually ends up being the end user in each of those industries, really takes you a long way. We even have data that shows individuals, people will lead their providers if they don’t have ease of use or ease of access. If you don’t give them easy tools to reach them, especially the younger generation will leave their providers. I’m not even sure if people want primary care providers right now. I think it’s incredibly important, but I don’t think people see value because we’re still working the old school way. So when you look at other industries, it’s like you go … I go to Marriott, I stay at Marriott all the time when I used to travel, they knew exactly what I wanted. I didn’t have to tell them every single time that I don’t like staying by the elevators, or I don’t like staying … I like my pillows like this, whatever it is, right? They knew.

  Nigel Ohrenstein: You like the upgrade to the presidential suite. They knew that, that was in your profile.

  Ash Zenooz: I always put that in there. Nobody ever listened to me, but that one got ignored. But the retailers know who you are, Amazon knows who you are. They recommend things to me on Amazon and I’m like, “Oh gosh, how did they know I’d run out of this?” Right? They know exactly what my needs are, my household needs. Airlines know, and they notify you to your point that you’re running late or flights are 15 minutes behind. Yet I wish I could say that healthcare had gotten there.

  Ash Zenooz: My husband went in to see his physician yesterday, waited an hour and 15, or an hour and 20 minutes in the waiting room, had to cancel his other calls, and it was a 15-minute appointment, but it was an hour and 15, hour 30 minutes of waiting. That would never happen in any other industry. Of course you could say, it’s a pandemic, things are delayed, right? But unfortunately, that’s just how it works in our industry. I agree with you, there’s incredible learnings that we can have that’s across industry that we can bring to the healthcare and life sciences arm.

  Ash Zenooz: And if we just collected that data on people, and understood their needs, and notified people that said, “Oh, we’re running a little bit late,” just giving people a heads up, treating your patients and treating your members, of course, we treat them like it matters from a healthcare perspective, but from a consumer perspective, it’s really important to also value time for people. And when you do that, I think you’re going to get a lot of loyalty out of people beyond just caring for somebody, right?

  Nigel Ohrenstein: 100%.  Yeah. Talk a little bit to us about your thoughts on vaccine distribution. I saw, I think it was a clip recently, where you sort of joked about we can’t do this on an Excel spreadsheet. And it sort of seems like there’s a little bit of an Excel spreadsheet might be an upgrade, based on some of the things that the consumer sees. We know there’s more that’s going on behind the scenes. So tell us a little bit about vaccine distribution and what do you expect to see here and what encouragement do you have based on the role that you’ve played?

  Ash Zenooz: Well, I mean, like I said before, I think technology has a huge role to play. But more importantly, before I get to that, I think we are dealing with the largest mass vaccination campaign, probably in the world’s history, if not US history. We are coordinating multidose regimens across multiple different types of vaccines for billions of people around the world. You must get the world to herd immunity, which means at least 70%, 80% immunity. We cannot have silos of immunity. I mean, we’ve learned that already. We’re seeing it with all the different strains that are popping up all over the place. So until we get the majority of the world’s population vaccinated, shots and arms, we’re not out of the woods.

  Ash Zenooz: Having said that, I am incredibly impressed by the scientific community, working with the government, on how quickly we brought multiple vaccines to market. I’m really encouraged by the new vaccines that are coming up for EUA right in the next couple of weeks. Hopefully we’ll have one, if not two more, in the US. But I think we’ve been hampered, we’ve been hampered because like I said earlier, we’re still working off of probably phone calls and sticky notes, which from what I remember from my government days, sometimes that’s what happens during a pandemic or a disaster response. And you would think that you would have lessons learned again from every single time we go through a disaster response, or a pandemic, or an epidemic response, but public health has unfortunately not been prioritized over the years.

  Ash Zenooz: We should have learned a long time ago from Ebola, you would think we’d learned from swine flu, or SARS, you think we’d learn from all the natural disasters, hurricanes, Maria, Irma, et cetera. But we continue to sort of follow in the same footsteps. And I’m really hoping that this time it’s going to be different. And I truly believe for that, you need to bring in technology companies as part of that solution, where real-time, quick collaboration, and having real-time data to access and to understand the landscape is really, really important.

  Ash Zenooz: I know for us, we’ve been working throughout this pandemic with a lot of different governments. We released products for, back in May, we released something called work.com. It was really to help organizations reopen safely, everything from an emergency response management to contact tracing to a command center. We’ve added capabilities for vaccine management and we released vaccine cloud, which really provides end to end capabilities for businesses and governments. But again, doing that in a silo doesn’t make sense, right?

  Ash Zenooz: So I think other technology companies, all the governments and healthcare providers and education facilities, all working together to provide that data into a central database, just to show that we are indeed getting people vaccinated makes a lot of sense. It also pinpoints areas. If you have the right data, you can then understand if there is vaccine hesitancy, or if there are areas where they’re not getting the right amount of supplies, or if they don’t have enough contact tracers, or if they don’t have enough people to give the vaccines. The only way you really understand that data quickly is if you have visibility to that data.

  Ash Zenooz: So I think that this time it’s going to be different. I’ve seen a lot of collaboration, but we still have a long ways to go. 

  Nigel Ohrenstein: Yeah. I agree with you. And I think the single dose vaccination is just incredibly important for large parts of the world that are perhaps not as privileged as large parts of America are, and to enable, as you say, to get the world to herd immunity. Even though in the scheme of it, they seem like they’re a couple of months behind. And as we write the history of COVID 19, perhaps to put a little bit of a bet, the Johnson & Johnson vaccine will have played a major role in vaccinating the world.

  Ash Zenooz: Yeah. And I really hope that all the different pharma companies can come together to support the few that are doing really well to get more production and supply out. Right? I would rather have a less effective single dose vaccination, where it keeps me from dying or getting severely sick. I would rather take the Johnson & Johnson vaccine and save the ones that have the 95%, 99% effective rates for the people that have more severe conditions and need those. I think we can prioritize, but we just need more supply out there. And there’s no room for vaccine nationalism. And if someone does not understand what that means, we’re going to be struggling in this volatile economy for a very long time. I think there are longer term, much more broader consequences to having nationalism during this time.

  Nigel Ohrenstein: As we think about post-pandemic I spend a lot of time thinking about the winners and losers post-pandemic in the US healthcare system. So I think it’s an amazing time in US healthcare because the innovation that’s happening, the financing that’s gone towards, and the focus on healthcare.

  Nigel Ohrenstein: I mean, I remember going to JP Morgan a decade ago and comparing it, actually, thankfully I didn’t miss it this past year, I must say, but move to JP Morgan 2020 and compared the difference in … Like a decade ago, it was all businesses trying to find the scarcity of dollars that we’re investing in healthcare. And when I was there in January 2020, the number of funds and investors that were coming to me and saying, “Do you know any companies that you think are really good that we can invest in? We’ve got to put our money to play.” And so that sort of transformation of healthcare becoming the focus of investment and innovation, the focus of the tech world, the innovation that comes out of other parts of the global community focused on healthcare. So it’s an amazing time in healthcare. And we can spend a little bit of time talking about those innovations, but first I’d love to touch on who do you think kind of, who’s going to be some of the winners and losers as we think about the sort of post-pandemic US healthcare system?

  Ash Zenooz: Yeah. I’m so excited, I can’t tell you, to be at this intersection of healthcare and digital right now. What an incredible time to be around to see this, right? I mean, if you look at … I was just looking at Rock Health report just yesterday, and they were talking about how the investments have gone from, I think it was like eight billion in 2018 to 14 billion in 2020. I mean, we are going through a pandemic, and venture money is pouring into digital health companies.

  Ash Zenooz: So, we’ve talked about digital transformation for a long time, but I think what the pandemic showed was you can’t just talk about it. You’re going to lose if you don’t participate in it. Right? And I think that’s what we’re seeing. The incredible uptake of telehealth and other sort of digital tools, remote monitoring, providing care for patients at home, all of these things have taken off, decentralized trials for pharma. These are all things that we’ve been talking about for years.

  Ash Zenooz: So I think to me, the winners are going to be a lot of these digital companies, it’s a David versus Goliath, and we are seeing that some of the retailers are seeing that there’s incredible opportunity to provide that personalized care access to where our patients need it right around the corner from where they live, rather than traveling 30 miles. Or you can provide primary care services from your desk if you’re able to do it through these remote channels. So from not naming companies, I think I’m seeing rapid uptake and success for telehealth companies. As you know, we’re also seeing much more focused, personalized, engaged service for chronic diseases, right? 

  Ash Zenooz: So I’m thrilled to see all of that innovation happening in digital health. And then I think on the life sciences side, we’re seeing so much from the research arm. Of course, there’s all that stuff around the actual pharmaceutical being done, but that recruitment of patients, remote patients, broadening their patient base as they’re doing these clinical trials through remote engagement, retention of all the patients, companies like Benchling and others that are doing these amazing things in this space. We’re going to see a lot more of that. But I’ll tell you one area that we haven’t really focused on or talked about, because we’ve talked about it for 10 to 15 years, is around interoperability. I think this is the time for interoperability. And I think in the next one to five years, if you don’t focus on, clearly the rules have come out, they’re going to make you exchange data.

  Ash Zenooz: But I think if you don’t participate, if you’re not part of that ecosystem with open data platforms and sharing, if you don’t preserve people’s privacy as you’re doing this and you are abusing people’s data, I think all of those things will, you will be left behind. So that’s where I see a lot of stuff moving forward.

  Nigel Ohrenstein: So fascinating that you go to this place around interoperability. One of the frustrations that I’ve always had is the government spent so much money on EMR deployment and there was no requirement or little requirements to drive into operability at that time. And for billions and billions of dollars I think we could have, looking back hindsight, obviously 2020 we probably could have done better. But particularly given your experience, as I’m rolling out the EMR across the VA, we’d love to get your perspective, how do we get the Epics of the world to play that? Is that where government needs to step in and just enforce it, because they’re just not going to do it as a private company?

  Ash Zenooz: It is the responsibility of people, people are demanding that they have easy access to their data, just like they have it for everything else. They want easy access and sharing their information. People want choice of providers, and they want to be able to go and share and have seamless exchange. And I think that’s going to drive, consumer behavior and market is going to drive a lot of change and shift.

  Ash Zenooz: If you look at some of the other industries, look at what Plaid has done for the FinTech industry, right? Providing an API where businesses and ecosystems have formed so that I can use my Venmo or I can use whatever other app to connect to my bank and have transactions with the click of a button. I want that for healthcare. And I know you probably want that for healthcare.

  Nigel Ohrenstein: Yes.

  Ash Zenooz: And it’s my money. I’m exchanging money. So it’s just as important, right? I mean, health is probably more important, I don’t know, but people think money and healthcare are two things that they’re regulated and has to be really secure. So as a consumer, I’m going to expect that sort of ease. And I’m not going to wait around for regulation, I’m going to demand it. I think we’re going to see more and more of that. So I think market is going to demand it. So we’re going to see a lot more with an API ecosystem in healthcare that’s going to start forming. And if I go to see a provider that’s in a hospital, and then I go see somebody for my telehealth visit, and I go let’s say to Livongo or one of these other services to get my virtual care, I expect that all of those are easily shared and interoperable so that they can provide the best care for me. So I think we’re going to start seeing a lot of that API ecosystem forming.

  Nigel Ohrenstein: Right. I often think about the fact that in the days when we used to travel, if I’m in Barcelona or trying to use my credit card, and for whatever reason, it takes more than three seconds for a response. And I’m incredulous, right? Why is it taking so long for you to charge my credit card? And yet we can’t cross the street, right? I’m here in New York. I can’t cross the street from one health system to the next, and then to have any knowledge of who I saw and what I did there. And at least not for the most part real-time today.

  Nigel Ohrenstein: So it’s fascinating what you said about the role of the consumer, because I think that’s one of the, ultimately the demands that will put pressure on the system. But I think, as I think about the role of the consumer, it needs to be in a way where the consumer ultimately is paying more, has more responsibility for their care in order for them to care more. It’s the old classic Dinah’s Dilemma, right? If we go out for dinner, and before dinner, you and I say we’re going to split it, and I see you order a salad, I’m going to be a little bit sensitive about ordering a $60 steak from wherever, because that’s not really socially very acceptable.

  Nigel Ohrenstein: But if we were to go with a party of 100 people and no one really knows what anybody else orders, I’d be like, I mean, “This is my opportunity to get that $60 steak that I wouldn’t normally get if I was paying for myself, because I’m just paying …” Yeah. And so that’s part of the problem with the consumer and healthcare, right? Is that the amount they pay has never been truly tied. And so in order for, I’m missing your thoughts here, in terms of for the consumer to play this role, do you see the consumer ultimately having to pay for more of their healthcare and that will push them to care more and to demand more as a result?

  Ash Zenooz: Well, I think we’re already paying more, we just don’t know it. Any of us will have employer sponsored insurance. I’ve been participating in this employer sponsored plans for over a decade or whatever now. And I’ve slowly seen that my burden has increased, and I’m paying attention, but I don’t know why it’s increased. I mean, if I had a choice and if I had all of the data visible to me, where I had a choice to say, “Okay.” It’s like the Yelp for healthcare with price transparency, right? If I knew that going to hospital X for my surgery was a lower cost, five star rating, and my employer would give me, I don’t know, $500 in my HSA, I probably would choose that, because I would know that that’s overall beneficial. Or if my amount that I would pay into the employer sponsored system would reduce, I would select that.

  Ash Zenooz: But unfortunately, as consumers, we are paying into the healthcare system, we just don’t have visibility and we don’t have choice right now. So I think, again, our shares, unfortunately, healthcare, one, is getting more and more expensive. So we are spending more, we will be continuing to spend more, but I think employers are also realizing that they’re spending more. And so a lot of these types of tools and datasets are going to start coming together where you’re going to have visibility into the amount of spend that the employer is spending on your behalf, and the amount that you’re putting in so that you can make better choices.

  Ash Zenooz: To your point, human psychology works really well. If I see that somebody else is eating healthy and working out, and that’s where I spend my time, I’m going to do better towards that. So there are going to be times where I prefer to go somewhere and I want to spend more, but for the most part, you’re going to be conscious about the amount you’re spending on your healthcare.

  Ash Zenooz: So yes, I think the burden will increase, it has already increased, but when we are active participants in the system, we will all have a better healthcare system. It’s like it’s easy to say somebody else should pay for healthcare, but we’re at $4 trillion spend. So the money has to come from somewhere. It doesn’t grow on trees. So I think we all have to do our part to figure out where can we reduce the costs? Where can we reduce some of that burden? Some of it obviously is the administrative burden, but some of it’s also just our free spending on this stuff. Absolutely.

  Nigel Ohrenstein: Yeah. And for someone who comes from England, which was obviously a dramatically different healthcare system, it was, I’ve been in the country for 21 years now, but it was amazing to me when I first came, how easy it is here to both access healthcare, and then also how much of it exists. And what I mean by how much of it is if you couldn’t get, thankfully I didn’t need it, but if I had needed an MRI, I think there are more in states, like I think states like Kansas and Missouri have more MRIs than all of England, which is population-wise quite dramatic in terms of the difference in size of population.

  Nigel Ohrenstein: So it’s definitely a challenge. And I think what lots of people don’t understand in the country is that the cost of healthcare and the continuous increase is actually going to be news around every industry, not just around the healthcare industry, and in order for us to remain competitive in the world, in every industry, we’re going to have to do more to fix sort of the cost and quality of care.

  Nigel Ohrenstein: And so us at Lumeris, we’ve dedicated our time to sort of figuring out value-based care. And how do we move people to be successful in value-based care? And it’s sort of the other side of that consumer piece to it, right? How do you align the right incentives between the payer or the physician so they play their role responsibly in delivering costs and high quality care.

  Nigel Ohrenstein: Post-pandemic, we’re seeing a number of health systems say, “I need to move faster to value-based care, because in a world where I get paid based on some type of capitation, I’m going to continue to get paid even if a pandemic hits.” But in a world where I just I’m reliant on seeing people and take that with the onset of some of the digitization we’ve spoken about, the move to home health, the need to take a greater role in managing that overall patient seems greater. Do you think the move to value-based care will slow, speed up? How do you see it from your vantage point?

  Ash Zenooz: I would say I would like to see it go as fast as possible, because I think it’s good for the system, it’s good for the person, and it’s good for the clinicians. But I don’t know if I would say it’s moving as fast as it should. I still see a lot of fee-for-service transactions, and all of my conversations for my own care, or when I see billings, are all around fee-for-service. So I’m not sure we really incentivize the system to move towards value based care as much as we talk about it.

  Ash Zenooz: I also, when I see … Look, I think it’s great that the retailers are getting into it, because it’s important to have easy access, especially where people don’t have access, like in remote areas, if they’re able to provide those services, I think it’s great. But I don’t see conversations there on value-based care. I’ve seen some of the retailers take more of a price transparency approach, and I think that’s great, but we’re talking about it in my opinion. I have not seen full-blown taking on risk for these types of things. The day that I see all of these digital health companies take on risk, providers taking on risk, that’s when I think we’re going to see much more uptick in this, but I’m still holding my breath.

  Nigel Ohrenstein: I agree with you. Yeah. I see the direct contracting program that came out from the government as a major game-changer actually in that evolution, and as you push to move those number of lives in fee-for-service into value-based payments, will dramatically shift, in my opinion, the pace at which we move to value-based care. So, maybe we’ll come back together in a few years’ time and do this again, and we’ll see if that turns out to be true. But if the government continues to roll out the direct contracting program, I think that’s going to be a major game-changer and look back and say, just same way we look back and say Medicare Advantage was a major game-changer in the way seniors received their care and continued to receive their care. I think we’ll look back and say direct contracting was a major game-changer.

  Ash Zenooz: I agree with you. I’d like to see it heading that direction, but I agree also, I think we’ll be coming back a few years from now talking about this, right? Not as quickly as we’d hoped.

  Nigel Ohrenstein: So Ash, we love to end with what we call the quick fire round. So what’s the best piece of advice you were ever given?

  Ash Zenooz: Yes, I was actually just talking about this with somebody. Someone told me a long time ago, early in my career, to have a kitchen cabinet. So, they said boards have cabinets, others have cabinets, you should have your own personal kitchen cabinet. So I’ve used that, and I have my own personal board, or my kitchen cabinet, and it’s been the most incredible group of people, they come from all different places, and it’s really helped me on my journey and I serve on other people’s kitchen cabinets. And so I think that was great advice that I was given.

  Nigel Ohrenstein: Yeah. So I actually, as part of my preparation for this, I watched your, I think it was StartUp Health a couple of years ago, and you mentioned kitchen cabinet. And I was really surprised that, I won’t mention the name of the journalist that was interviewing you, but he didn’t know what a kitchen cabinet is. But I think it’s such sound advice and I assume you know the origins of it, right? The origins of it was Golda Meir, the first female prime minister of Israel, who literally had a cabinet to her kitchen and she cooked them dinner and they discussed the sort of most pressing topics.

  Ash Zenooz: Margaret Thatcher did that too I think.

  Nigel Ohrenstein: Yeah. That’s right. But obviously very sound advice. And I’m assuming your kitchen cabinet, I know we’ve lost the quick fire, but this is a fascinating point, I’m assuming your kitchen cabinet comes from different people from different stages of life, industry, who can provide sort of a rounded perspective.

  Ash Zenooz: Absolutely. I mean, especially now that I’ve spent time in different parts in technology, I now interface with people across different industries. I’ve spent time in government, spent time in the clinical side. I have now multiple little cabinets, sometimes my worlds come together, which is always really interesting to see. I wish at some point post-pandemic I can bring all of those wonderful people together, but yes, all different perspectives, which has been great.

  Nigel Ohrenstein: Amazing. What do you do to have fun, relax?

  Ash Zenooz: Oh gosh, I don’t know if there’s any time for that right now, but I’ve been meditating, which is new for me. I do about 10 to 15 minutes to calm my mind and take some deep breaths. Definitely having kids at home, and homeschooling, and working requires a lot of that. So that’s where I’m spending my time.

  Nigel Ohrenstein: Right. That’s great. And finally, if you could change one thing in healthcare, what would it be?

  Ash Zenooz: I have so many things on that list. I would take the approach that, I hear a lot of companies talking about customer obsession. I would say, bring that to healthcare to patients. I’d say members, but I’d say more importantly patients. Patients, when you think of them, are sick. So I would say be very, very obsessed with the person that you are taking care of, patient obsession from every level, right? Whether you were thinking about the clinical care, billing, engaging with them for some other reason, having that patient-centric point of view and being obsessed with having delight of the people that you’re caring for, I think is the most important thing. So I would say anything that you’re building as a technologist in these health systems, any interactions have to be super obsessed with your patients delight. That’s what I would change.

  Nigel Ohrenstein: Great. Thank you. Thank you for joining us today. Thank you for what you’re personally doing to transform the healthcare industry, what Salesforce is doing. I think as we discussed, there’s so much opportunity right now, and so much room for people with your experience and your mindset to really make a difference. So, thank you for everything you have done and continue to do and thank you for joining us today.

  Ash Zenooz: Thanks for having me, Nigel.

  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. I hope you continue to stay safe and healthy, and please join us next time as we tune healthcare. This is Nigel Ohrenstein in New York.