Jan 23 2020 | Podcast | By

Tuning Healthcare, Episode 4: Embracing Risk and Enhancing the Patient Experience

Jordanna Davis, President of the Rockingstone Group

With her extensive experience in healthcare policy, Jordanna Davis, President of the Rockingstone Group, shares insights around the industry’s transformation and new initiatives such as Direct Contracting.

In this episode of Tuning Healthcare, Jordanna discusses the evolution of healthcare policy as it pushed the industry toward value-based care models, highlighting what CMS and providers have learned over time and where we are today with value-based care. Jordanna also explains why the patient experience is so critical for the survival of provider organizations.

“The Center for Medicare & Medicaid Innovation (CMMI) has put out many opportunities for providers since it was initiated under the ACA. They have moved progressively from lower levels of taking on risk to higher levels of taking on risk. … [However] The Medicare Shared Savings Program (MSSP) Track One was not preparing providers to take on real risk and accountability in a way that a more robust program may have. So it was important for that cultural change, but it may not have actually created that infrastructure change that was needed. So here comes Direct Contracting, which says actually, “Let’s open the doors more wide open.””
– Jordanna Davis

In this episode, Jordanna connects with Lumeris Senior Vice President Nigel Ohrenstein about:

  • Insights from working in Capitol Hill and on the Affordable Care Act (ACA)
  • Benefits and unintended consequences of the passage of the ACA
  • Why transparency plays a critical role in transforming healthcare
  • Why consumerism in healthcare is a huge challenge
  • The newly proposed Direct Contracting model from CMMI
  • How provider appetite for risk-bearing models is changing
  • How to create virtually integrated delivery networks

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  • Read Transcript

    Nigel Ohrenstein: Welcome to this episode of Tuning Healthcare. I’m joined today by Jordanna Davis, the president of Rockingstone Group. In this episode of Tuning Healthcare, Jordanna and I discuss health care transparency and the role of the consumer. How should the physician-patient relationship evolve? What is the role of government and in particular, the new program that the government has recently released called Direct Contracting? And what are the pathways for health systems as they move towards value-based care and in particular, how do we create virtual integrated delivery networks? Join Jordanna and me in New York City, as we Tune Healthcare.

    Nigel Ohrenstein: Jordanna thanks for joining me in Midtown Manhattan on this cold winter morning. Happy birthday. I’m sure you couldn’t have filled with anything better to do for your birthday.

    Jordanna Davis: Cake and podcasts. It’s a birthday special.

    Nigel Ohrenstein: Are you a big birthday person?

    Jordanna Davis: I’m a big birthday person, but as we were talking about earlier Nigel, it’s also my daughter’s birthday today. So my birthday is now sort of half mine and half hers, so I do my best.

    Nigel Ohrenstein: Yeah, so you could have half birthdays.

    Jordanna Davis: Right.

    Nigel Ohrenstein: Well, thanks again for joining me– president of your own company. Tell us a little bit about the journey. Spent a lot of time at Sachs, you’re on the Hill, obviously you come from a healthcare family. How’d you get to where you are now?

    Jordanna Davis: Well, certainly coming from a healthcare family, I was determined to not go into healthcare, which I obviously failed at catastrophically. I was always really, really interested in politics though. And so, when I graduated from college, I started working on the John Kerry for president campaign and that really led me eventually into working in the Senate, where I worked for Russ Feingold and I worked for Sheldon Whitehouse, two extraordinarily thoughtful, kind, wonderful members. And I really lucked out working for them. And then I was able to work in the Affordable Care Act, and that was of course a real, real highlight of my career and my life to this point. And after the Affordable Care Act passed, I went, came to New York back to where my family is and started working in consulting where a lot of hospitals really needed a lot of help learning about what was in the bill, how to adapt to it, how to make the best of it.

    Jordanna Davis: And I did that for seven years and then started my own shop with a couple of my friends and colleagues from Capitol Hill and we’ve had a really good time working together over the last several years.

    Nigel Ohrenstein: Excellent. Congratulations.

    Jordanna Davis: Thanks.

    Nigel Ohrenstein: So Affordable Care Act, a success?

    Jordanna Davis: I think so.

    Nigel Ohrenstein: Why?

    Jordanna Davis: The Affordable Care Act was probably more of a reflection of what had already been going on in the country than a real catalyst, but we had a massive coverage problem in this country. Millions and millions of Americans had not enough coverage or no coverage at all. The coverage that they had was not paying for the services they needed. It creates extraordinary insecurity in life. It’s just not a way to live. I personally believe healthcare is a right. We can talk about Medicare for All. I probably wouldn’t go as far as Medicare for All but the ACA won an extraordinary way to providing security for millions of Americans in their lives.

    Jordanna Davis: It didn’t so much focus on some of the things I think we need a lot of work on, like quality moving to risk, accountability. We sort of started to dabble in that, but the reality of the debate in Washington is that it’s easier to talk about coverage issues than it is to talk about changing the delivery system. The expertise is not really there frankly among elected members to get into the details of how the delivery system works. So you end up focusing on coverage and that’s what you got in the ACA. But of course there’s a really strong argument that everybody needs to be in the system before you improve the system and that’s really what we achieved in the ACA.

    Nigel Ohrenstein: Having been someone who worked on the Hill, as you said, for great people, isn’t it problematic that our elected leaders don’t truly understand the healthcare system?

    Jordanna Davis: To me on the Hill, there are those who come to their offices thinking that they know everything about the world and there are those that accept that they don’t. And as long as you continue to have members, and those are certainly the ones that I worked for and many of the colleagues of those that I worked for who understand that there is much to learn and much to listen to, then we have members who can make a difference and make positive change. You don’t have to be a supreme expert in everything. You simply won’t be. And we can’t stop ourselves towards progress waiting for the perfect answer.

    Nigel Ohrenstein: So as I look back on the Affordable Care Act, I see what I consider three unintended consequences, none of which I think are sort of Democrat ideals. So the three that I see first is, I think it’s led to this merger among payers. I think that’s sort of one unintended consequence there. They saw sort of a risk to that business model and when large companies see a risk to their business model, they obviously try and go out and get bigger to defend their business model for an extended period of time. The second unintended consequence is the risk shift to providers. I don’t think that was intended to the extent that it has evolved. And the third is the cost shift to the consumer. So would you agree with me those unintended consequences of the Affordable Care Act and is that success or is that something that we should be concerned about?

    Jordanna Davis: I’m not sure I agree that risk shift to the provider is an unintended consequence. The ACA was the bill that introduced CMMI (Center for Medicare & Medicaid Innovation). It introduced ACOs. It introduced penalties on HACs [Hospital-Acquired Conditions] and other kinds of preventable issues. There was certainly a real understanding before the passage of the ACA that there was a disconnect between the payment model and the delivery system, and that you had to create a more accountable structure for providers in order for them to align the best care with the best bottom line. So I don’t think it was an unintended consequence, but certainly the train has left the station and is barreling down the track on that in a way that I’m not sure was intended. I’m not sure the speed of it was intended.

    Jordanna Davis: The cost shift to patients was a real challenge in the negotiation on the bill. I think Democrats would have liked probably to have maybe more robust models, maybe not including a catastrophic option on the exchange, but those were things that had to be included for passage. And certainly consumers have in my view, far too much responsibility. And we can talk about this more, far too much responsibility in health care. The notion of patient as consumer, I actually personally think is a farce. And I think we’re moving far too quickly down that road.

    Nigel Ohrenstein: So let’s talk about that. If I want to buy anything or any type of service or product in every other aspect of my life, right? I can walk into, we’re not too far from Fifth Avenue. I can walk into any type of department store and I could make a cost benefit analysis, right? I could say, I want a mattress. Okay, this mattress is X dollars. This one’s two X, this one’s three X. I can pretty much understand who knows what makes that one mattress more expensive than the next. And then I make a decision based on how much I want to spend and how much I like my sleep and whatever else I use to make that decision. I guess what you’re saying is that the consumer/patient can never make that decision in healthcare.

    Jordanna Davis: Never may be really strong. I think almost never is right. We just talked, sure. You go to fifth Avenue, you go on Amazon. To me, Amazon is the greatest example. Last night I noticed that I needed to buy trash bags for those tiny little bathroom cans. Who on earth knows how to buy these things, right? But what do I do? I measure the trash cans, I go on Amazon. All the information is there. How much do they cost? Other people have reviewed these silly little bags. Does a Q-tip stick through it? I mean, I’ve got all the information I need to make a choice about value and quality. I don’t know anything about the healthcare providers. I mean, look, all you need to know is look at the different evaluators of hospital quality and the answers that you get when you look on these websites are wildly divergent.

    Jordanna Davis: If you look on Leapfrog, for example. When I look at the hospitals I know best in the New York region, I fully cannot comprehend what I see on the Leapfrog data. There are hospitals that are rated A’s that most people wouldn’t walk into and there are great institutions that are labeled C’s. And I mean maybe that’s right in certain aspects of quality within these organizations, but in total it can’t be an accurate driver of patient information. I’ll give you another example. So Governor Cuomo announced this, I think it was a week or two ago, that he’s going to put together a government website called New York Healthcare Compare. And he’s going to put volume data, quality data, and cost data, for sets of services at New York’s institutions so that patients can go on websites and figure out where they should shop. That one of the reasons costs is high, the press release says is that competition is low because consumers aren’t able to shop.

    Jordanna Davis: So one of the real challenges of this, and I support it, I support transparency. I think we have to move in this direction. But the question is, what are we being transparent about? In 2019, Governor Cuomo already required that the Chargemasters be made public. These are Byzantine documents. The information is voluminous. It’s confusing. I guarantee you no consumer in New York has ever looked at this data and learned anything useful about their own healthcare situation. So we also already have a website in New York called FAIR Health, which was created years ago. I think when the governor was the attorney general out of a lawsuit. And it supposedly I believe has this kind of cost data from hospitals all over the region. If we walk downstairs to Midtown Manhattan on the sidewalk and ask the first 10 people that walk by whether they’ve ever heard of FAIR Health, nevermind used it. I’d be shocked if one person said they’d ever used it. So one of the real questions is not-

    Nigel Ohrenstein: I think you probably increased that to like 10,000.

    Jordanna Davis: Okay. So we’ll go down when we’re done. We’ll see. One of the real questions isn’t: “what do things cost?” It’s “what does it cost to me?” So if I go on New York Healthcare Compare… Let’s say Nigel, you and I, it’s my birthday today, right? Maybe I’m going to need a knee replacement this year. I’m getting older, right? I actually made a resolution to run a 10K, so who knows? That might happen. So Nigel, you and I are going to go get knee reconstruction. So the cost to me, I have Cigna, is not the cost to you, whatever you’re on. Your company and my insurance company have negotiated completely different deals even with the same institution in New York. You and I can walk through the same door in Manhattan, get the same procedure, have totally different bills that come to our house.

    Jordanna Davis: So I love that Governor Cuomo is putting up New York Healthcare Compare, but I can’t envision technically, logistically how I’m going to see on that website what it means to me and what it means to me is what’s most important and it’s really hard to parse out that kind of data. The other thing I’d say about-

    Nigel Ohrenstein: But don’t you think we should know that?

    Jordanna Davis: Yes.

    Nigel Ohrenstein: Right. I should know when I walked through the door, how much is the surgeon going to cost me? How much is the anesthesiologist going to cost me? Right. Are there any other hidden costs? I should understand that and be able to look and say, “Okay I’m going to make a choice to go to Mount Sinai for this knee replacement or I could go to an urgent care facility, some type of facility outside that might cost me three quarters of that.”

    Jordanna Davis: I totally agree.

    Nigel Ohrenstein: And I can then make a judgment based on understanding the cost and also looking at the different quality aspects.

    Jordanna Davis: So while I agree with that 100 percent, and I would love for there to be a world in which we could figure out how to get that information to people in a digestible and actionable way. You and I shopping for elective procedures, non-urgent, non-acute procedures is not where cost is in the healthcare system. Cost is in acute, inpatient, emergent, chronically ill individuals, many of whom have mental health comorbidities that will not allow them to do the kind of research, have the energy, have the resources to get to these answers. We were talking a little bit before, I went to see an ENT for some sinus headaches I’d had for years. He was lovely. We had a wonderful interaction. He was very helpful, we talked, I thought it was a consult. We went in three quarters of the way through our 20-minute appointment he said, “Okay, I’m just going to look up your nose with this camera.”

    Jordanna Davis: I said, “Okay.” He sticks this fabulously small and detailed little camera up there and we see the insides of my nose on the screen and it’s kind of fascinating. I say, “Thank you.” He gives me a care plan. We walk out. I get a bill for $1,500 yesterday and I look at this bill, and the bill says sinus endoscopy surgery. And I said, “What the heck is that? Is that what I had? I went in for a consult.” So here I am, a reasonably educated consumer, I can’t understand this bill for the life of me.

    Jordanna Davis: It’s not like when we got to that moment in the appointment, he said, “Okay, now I’m going to stick a camera up your nose. This is going to cost you $1,500.” There was no decision node for me. And of course I would have called my insurance company had I known something like that was going to happen. But the system doesn’t function so that I can be a reasonable consumer. And so when we put all of these responsibilities on consumers, we’re really just abdicating the responsibility of the system, of the delivery system, of the plan to take care of us. And frankly of government in my view, having spent time in government. Government’s role is to protect consumers from that which they don’t understand.

    Nigel Ohrenstein: And so in that list, you didn’t say physician?

    Jordanna Davis: Well delivery system, but yeah.

    Nigel Ohrenstein: Okay. So, because one of the things that we are passionate about at Lumeris is how do we enable that physician-patient relationship, right? How do you create that trusted relationship between a physician and a patient? Because we would also acknowledge that ultimately there are things that are too complicated. Even if I have the time, it’s going to take me 10 months to learn it, research it, assuming I even have the capacity to make that informed decision. Obviously the physician’s gone through many years of training. So we’re passionate about creating that physician-patient relationship, that sort of forms at the center of that delivery system. How do you think we’re doing as a country towards that? What would you like to see happen both either from the private sector or the public sector to speed that up?

    Jordanna Davis: Such a great question, and I go back to the ENT example because I walked out of the appointment feeling like I’d had a great experience. I was nervous. He was kind. He was gentle. He explained everything to me about something I’d been dealing with for more than probably a year or two. I feel better. And then I got the bill and I felt alienated. I felt angry, upset, confused. How did this happen? How did this guy do this to me? Now I understand the delivery system enough to know he’s got no idea what he billed me. He filled out some codes on a chart and it went to some central office and I got a bill. And I still don’t know whether it’s right or wrong. I’ve got to call them up and figure out whether that’s really what he meant to bill me for.

    Jordanna Davis: But the separation of the physician from that business, from my decision really creates an alienation that’s really troubling. And then people lose that trust. And the truth is, the really important part of the patient as consumer is that the patient must be a major participant in their care plan, in the implementation of that plan and taking responsibility for it, in making decisions together with the physician. And you lose that partnership when you get alienated by the finances and the bureaucracy. I probably got eight different bills when I had a baby, like I couldn’t even figure that out. Really? Like the hospital can’t figure out how to give me something more consolidated? You can destroy a great experience that a hospital or a physician works so hard to have with you at the bedside, by just a terrible back office situation.

    Nigel Ohrenstein: The government you said it should be responsible for regulating and then create an environment… I’m putting words perhaps into your mouth…that enables the private sector to innovate? At least say these are the words I think I’m putting in your mouth: You would advocate that as long as the government creates the right environment in the case of the Affordable Care Act created coverage, now it’s beholden on the private sector to innovate, to figure out how to create models that move the healthcare system forward.

    Jordanna Davis: Yeah. But we see a push all the time for more responsibility on the consumer, which I think is a ruse. It’s just a guise for making the insurance companies less responsible for paying for things. And I think it’s a really dangerous way to go.

    Nigel Ohrenstein: What would you like to see the insurance companies do?

    Jordanna Davis: Well, let me say one thing on the other point. I think a good example of this is Republicans for a long time have been pushing what’s called association health plans. They were pushing it before the ACA, during the ACA, post the ACA. These are plans that you could sell across state lines. And this is a great example of where consumers fundamentally wouldn’t understand. So let’s say I live in New York and I’m able to buy a plan that’s sold in Alabama where I assume, I don’t know, I assume the regulations are probably looser than we have in New York. And I go, “Holy moly, this plan is a third of the cost of what I can buy in New York. Like these guys really know what they’re doing.” And then all of a sudden I go in and I get a service and I’m sitting there with a $3,000 bill, right?

    Jordanna Davis: Government has to protect us from what we can’t possibly understand. Association health plans make things look cheap and that looks attractive, but we have to understand what happens on the back end of that.

    Nigel Ohrenstein: Right. So what would you like to see the payers do? You clearly have frustration, which is not uncommon, right? There are plenty of people that share that same frustration. What would you like to see the payers do? What would you like to see the hospital systems do? And I guess in let’s throw in the individual providers as sort of a third category of sort of major players in the healthcare system.

    Jordanna Davis: Right. So one thing that payers are doing that I really like is they’re making their EOBs so much clearer. I mean, I’ll give a shout out to Cigna. We switched to Cigna on my husband’s insurance a couple of years ago. They pay very quickly and their EOBs are clear.

    Nigel Ohrenstein: How many people on the street of Manhattan will we need to ask before they can tell us what an EOB is?

    Jordanna Davis: Excuse me, an explanation of benefits. The document we receive after we see a doctor that’s basically our receipt.

    Nigel Ohrenstein: More or less people that know about FAIR Health.

    Jordanna Davis: Fewer, maybe fewer. This is a problem with healthcare, too many acronyms. What can the providers do? I’ve worked with a provider in Connecticut for a couple of years that does something actually really, really interesting when folks are first diagnosed with cancer. They have their diagnosis, are obviously really emotional, concerned. They’re taken to another office where they’re given an estimate based on their insurance of how much their care plan is going to cost them. And I think it really reduces the anxiety of the whole thing. So here’s your, we talked about it before you’ve got your clinical care plan and you’ve got the financial plan of what’s going to happen here. And hospitals are capable of that. They’re bad at it. They need to get better at it, but they’re capable of it. And that’s a really important move when we talk about patient as consumer for systems to start thinking of patients as consumers and as people who need this kind of services.

    Nigel Ohrenstein: So let’s talk about Direct Contracting. We recently co-authored an article on Direct Contracting, which you can, if you haven’t read, you can read on the Lumeris website. You can download it there. I believe Direct Contracting is a game changer as we think about moving systems to value-based care. I think that one of the issues that many systems have is that they want to move to value-based care, but either they don’t have enough lives under value-based care arrangements or the payers that they work with are moving more slowly than they would like. And therefore they realize they need to move towards value-based care arrangements, but they can’t yet fund the infrastructure. They can’t yet cross the chasm as I like to say, in order to move away from fee-for-service.

    Nigel Ohrenstein: And I think Direct Contracting is a fascinating program, obviously still more regs to come out, but potential here to be a real game changer in, particularly as I think about how health systems move to value-based care. What are your thoughts on Direct Contracting? Are you as optimistic as I am or how do you think it’s going to evolve?

    Jordanna Davis: I’m really optimistic about it. A quick recap on what the heck is Direct Contracting. Of course, CMMI has put out many opportunities for providers since it was initiated under the ACA. They have moved progressively from lower levels of taking on risk to higher levels of taking on risk. And what we’ve seen is that this is a movement that has made no difference whether we’ve had a Democratic administration or Republican administration. I think my dog at this point could probably be running CMMI and move us towards risk. It’s just the path is so clear. The inertia is so clear in this way, the momentum. And what we’ve actually seen if we just go back in the timeline a little bit, which is interesting. As we moved towards Direct Contracting, the Medicare Shared Savings Program, the ACO program, was a great way for a lot of providers to start drinking the Kool-Aid.

    Jordanna Davis: It gave them an opportunity to try. The question is, did trying really work? I think it worked in the sense of changing people’s minds, of getting a lot of hospital leaders to say, let’s give this a shot, to start talking about it to create a culture of maybe moving towards change. But what also we know happened is that when Seema Verma came in, when Alex Azar came in, and they put out a rule that basically said MSSP is a little bit weak. This Track One option that we have is a little bit weak. We want to move everybody towards risk more quickly and more deeply. And I think all of us would support that. But what happened in the data? There was some great data that was published in Health Affairs and it basically said, “Oh, you know what happened? There was a really rapid fallout rate for folks that were at the end of their contract because they didn’t want to move to more rapid risk.”

    Jordanna Davis: And in fact, who were those guys? They were people who were in Track One of MSSP. What does that tell you? That MSSP Track One was not preparing providers to take on real risk and accountability in a way that a more robust program may have. So it was important for that cultural change, but it may not have actually created that infrastructure change that was needed. So here comes Direct Contracting, which says actually, “Let’s open the doors more wide open.” And so there’s three different opportunities for providers to participate and we have a lot of data from CMS now about two of them and not the third. So most people are looking at what’s called the Professional population-based payment model or the Global population-based payment model.

    Jordanna Davis: These are going to be risk adjusted, monthly capitated payments for enhanced primary care services. One has 50 percent savings losses, one’s got 100 percent savings and losses. We’re really talking about a lot more flexibility for providers, a lot more opportunity for them to provide innovative services for patients and a lot more opportunity to have success. So I think it’s really promising.

    Nigel Ohrenstein: So as you think about the healthcare system, right? The CEO of a health system comes to you and says, “Jordanna right, I need to, I need to move faster to value-based care. Right? I recognize the writing’s on the wall for fee-for-service. What’s the first piece of advice that you would give that CEO?”

    Jordanna Davis: Don’t start your own plan.

    Nigel Ohrenstein: Why do you say that? So there are 103 I believe health systems, maybe it’s 109. Somewhere in that range of health systems that own a plan. Some have obviously been highly successful. Like obviously Kaiser being the preeminent example of that and some who have struggled. So you’ve obviously gone to the struggled side. So why would you give them that advice?

    Jordanna Davis: Well you created the hypothetical of somebody who was kind of starting for the first time, right? And I think a lot of people think for the first time, let me integrate the whole vertical. I can do this. Kaiser’s doing it. And too few people say “Kaiser’s different.” It’s just a different situation. It’s a different market. It’s a different history. I mean you look at a market like New York, it is so highly competitive. You just have a very different situation than you have elsewhere. What’s really important about how quickly the healthcare market is changing right now is for providers and payers and everybody to remember, as everybody’s blending into everyone else’s market: Do the thing you’re good at, and let other people do the things they’re good at. So partner with a plan, find a plan that wants to partner with you and give you risk. A collaborative partner, maybe some of the smaller partners are more willing to do that. Harder to change your business practice in your model with a smaller plan, but go out and find maybe the biggest plan you can.

    Nigel Ohrenstein: What happens if you can’t find one?

    Jordanna Davis: Then maybe you do start your own, I don’t know. Or you go to CMMI and see what opportunities are available or some clients of mine have gone to the state and said, “Give me an interesting arrangement on Medicaid.” Medicaid is harder obviously. MA I think is probably a more advantageous model. Medicare Advantage, but you know there’s opportunities out there for you to do it.

    Nigel Ohrenstein: As you think about the health system moving up, I think what we’re talking about is how do they take control of more of the premium dollar, and there are multiple ways to do that. Starting a plan is obviously the most advanced of those because then you’re at full risk for every dollar. But there are obviously multiple steps in between. And we’ve been on a mission now for a decade to create what we call a virtual integrated delivery network. Kaiser obviously very successful. Many other examples are held out like Geisinger that have created an integrated delivery network, but I think even those organizations have found when you try and take it out of the home market, it’s significantly harder than it is in the market in which you sort of created it. That’s sort of problem number one.

    Nigel Ohrenstein: And then problem number two is something like eight percent of the population receive their care today in an integrated delivery network. Even if you claim that’s going to double, let’s say to 15 percent. You’ve still got 85 percent of the population that is not going to receive their care in an integrated delivery network. And so whilst they’re held out as a great example of care, it’s not a solution for the country.

    Nigel Ohrenstein: And so we’re on a mission to create what we call virtual integrated delivery networks where you can have the same outcomes if you create the right conditions, incentivize the providers correctly, get the right payer contracts, which is what you were talking about. Make sure that you sort of change the workflow of the physician to engage them. Move care management closer to point of care. There are lots of things that are necessary to do. These are all hard work things that take time to do that.

    Nigel Ohrenstein: As you think about that, I’m very interested cause you obviously look at it very much from a policy perspective. Is there more you’d like to see the government do to help enable this? As you said, the train has left the station. What would you like to see? Would you just, is there more you’d like to see the government do?

    Jordanna Davis: So my dream world solution, which is never going to happen, is that we can look holistically at people. So one of the challenges is that we’ve got folks who are dual-eligibles. They’re the most expensive individuals we have in our system. It’s hard. We have the PACE program, which is one shining example of doing a terrific job of integrating these services. Very, very few people are enrolled in a PACE program. What we also have is we have folks who are on Medicaid for example, who are also drawing from other parts of state resources. They are living in public housing. They are receiving nutrition. They are using public transportation. They are maybe in the justice system. And if we can, as government start coordinating across the silos of these budgets and these programs and these departments, we can provide such better care for some of these people.

    Jordanna Davis: Now our brains will explode by trying to figure out how to count costs and savings because we live in this ridiculously black and white world of government budgeting. But to me there is a wonderful future for people, if we could coordinate the resources that we are allocating people across all of these areas.

    Nigel Ohrenstein: So a topic that I really want to talk to you about actually is golf. So I don’t know whether everybody knows this. So probably not many people know this. Jordanna was the captain of the Yale golf team. So for people that don’t know you, how tall are you? Five…?

    Jordanna Davis: I’m like five, four.

    Nigel Ohrenstein: Five, four right. So first of all, have you ever showed up to a corporate golf event and pretended you couldn’t play golf?

    Jordanna Davis: No, but I think everyone else thinks I can’t. It’s a fun game.

    Nigel Ohrenstein: It must be amazing that, I mean, there must be any number of times you’ve shown up to play and you’ve got sort of these macho guys that think that they’re great at golf and let you walk forward to the ladies tee and you probably drive the green.

    Jordanna Davis: More times than you can count. It is one of the great pleasures of my life.

    Nigel Ohrenstein: Greatest. I could imagine it would be. From the last decade, we just started a new decade, favorite golfing moment?

    Jordanna Davis: Oh, favorite golfing moment? Wow.

    Nigel Ohrenstein: You can go longer than a decade if you want to, but just-

    Jordanna Davis: There are so many. My first hole in one, I was 15 years old. I’ve only ever had one hole in one. I shouldn’t have said first. That was really misleading. I’ve had one hole in one. I was on the golf course with my Mom, my Dad and my Grandma, and I was 15 years old on my Grandma’s golf course in West Palm Beach, Florida. And I hit a not great shot and it went into the hole and we all freaked out. And to this day in my parent’s house, in my bedroom is the plaque of my hole in one.

    Nigel Ohrenstein: Pretty impressive. So I’d like to end with what we consider the quick fire round. A couple of quick questions to end the podcast. So let’s start with golf. Your favorite golfer?

    Jordanna Davis: Freddie Couples.

    Nigel Ohrenstein: Best piece of business advice you were ever given?

    Jordanna Davis: From my mother, don’t work for anyone else if you can work for yourself.

    Nigel Ohrenstein: And finally, if you could change anything in healthcare, what would it be?

    Jordanna Davis: The silo-ization of the way we deliver services.

    Nigel Ohrenstein: Jordanna, thanks for joining me in New York today.

    Jordanna Davis: Thank you, Nigel.

    Nigel Ohrenstein: Thanks for joining us today for this episode of Tuning Healthcare. Don’t forget to follow us on your favorite streamer, whether that be Spotify, Apple Podcasts, or SoundCloud. Please remember to rate us. This is Nigel Ohrenstein, and please join us next time for the next episode of Tuning Healthcare.

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