Mar 5 2020 | Lumeris News, Podcast | By

Tuning Healthcare, Episode 5: An Accountable Primary Care Physician Talks Value

Tom Hastings, MD, Esse Health

As a practicing accountable primary care physician, Dr. Tom Hastings shares practical insights on how value-based care has helped transform the way he and his team deliver care. With a passion to always continue learning, Dr. Hastings discusses critical elements of today’s healthcare system and how physicians can better align with their patients, care teams and payer partners.

“I try to put myself in my patients’ shoes. It’s with great empathy and compassion that I try to always put myself in the patient’s shoes. What do they want? And what is it that they really want? Because they might think they want something, but what they really want might be something completely different. So, getting to that value is important.”
– Tom Hastings, MD

In this episode, step into a doctor’s office and listen to Dr. Hastings talk about his practice with Lumeris Senior Vice President Nigel Ohrenstein as they discuss:

  • A day in the life of an accountable primary care physician
  • Team-based care and workflows that enable patient and care team satisfaction
  • The importance of finding what is of value for patients
  • Advice for physicians new to value-based models
  • How a Collaborative Payer can be a value-driven companion for physicians
  • How ongoing learning, transparency and continuous improvement help drive better care
  • What to change in today’s healthcare system

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  • Read Transcript:

    Nigel Ohrenstein: I’m joined today by Dr. Tom Hastings, a true accountable primary care physician in St. Louis, Missouri. In this episode of Tuning Healthcare, Tom and I will discuss workflow and how an accountable primary care physician changes their workflow. We’ll also talk about the transition to value-based care and how you do that, and how, in today’s age, we have plenty of information, but we’re common-sense poor. Join Tom and I in his medical practice in St. Louis as we tune health care.

    Nigel Ohrenstein: Tom, thanks for having us in your practice.

    Dr. Tom Hastings: Great to have you.

    Nigel Ohrenstein: What excites me about being in your practice, specifically, and then ultimately to have this conversation with you, is that you’re at the epicenter of the transformation to value-based care. You are a primary care physician who’s been practicing what I would call accountable primary care for many years. In fact, when I think about an accountable primary care physician, my image is Dr. Tom Hastings.

    Nigel Ohrenstein: But let’s start at the beginning. Did you always intend to be a physician?

    Dr. Tom Hastings: No, I didn’t. I got excited when I was a senior in high school and I took an anatomy physiology course, and that’s when I fell in love with the whole thing. I was a C/D, C/B student all through high school, never really studied, never really did anything, and I didn’t get really excited until I got into college and started really taking some deep dives into the premed stuff.

    Dr. Tom Hastings: It came easily for me. I liked it a lot. Part of the reason why I do general is, I like everything. And so it’s fun to learn and continue to learn. It’s been a great life. I’ve been highly professionally satisfied doing what I’m doing.

    Nigel Ohrenstein: Which is obviously an incredible statement from a primary care physician. Many primary care physicians you interact with feel burned out, or they feel that they’ve been unsatisfied, they’re not practicing at the top of their license. But, for you, it’s been the opposite.

    Dr. Tom Hastings: Exactly.

    Nigel Ohrenstein: Why is that?

    Dr. Tom Hastings: Well, I think there’s a number of different reasons. I think a lot of it is workflow and trying to get the workflow right to be more efficient, make your office work better. We work at the top of our license, we have our MAs (medical assistants) work at the top of their license. So, we employ and delegate frequently and often to make our lives better, and it also makes everybody’s professional life much more satisfying. Everybody feels like they’re contributing as a team. So, it’s team-based care. I think, before, we called it team-based care. There’s a lot more delegation, I think, here.

    Dr. Tom Hastings: And I think the patients like it because they’re served better, the response time’s better, and they like our office, and we like coming to work. And that’s half the battle.

    Nigel Ohrenstein: Right. That’s great. So, we’ve jumped straight into one of the things that I’ve noticed from visiting your practice over the years is that you just have a different workflow to many other practices I’ve been into, either as an executive at Lumeris or as a patient.

    Nigel Ohrenstein: So, tell us a little bit about your workflow. How does the day start, what is it that’s so unique about the way you look at the patient, both from the beginning, in the work you do before the patient ever walks in the door, all the way through to how you manage your day? We were chatting just before we went on air about your inbox, right?

    Nigel Ohrenstein: So, take us through the Hastings workflow.

    Dr. Tom Hastings: This is kind of exciting to talk about, because, you know, the Superbowl’s coming up, and Andy Reid is this great coach for the Kansas City Chiefs for years, and it’s all about game plan and planning. So, when I think of our morning huddle, I use that analogy frequently; it’s a game. It’s a sports game. It’s a game with a purpose, though, because the purpose is to provide better care and to have a better plan for your day.

    Dr. Tom Hastings: Often, days as a primary care physician is just full of the unexpected. So, if you can plan things better, then when the unexpected things pop up, at least you have a plan to handle those kinds of things. For instance, when we look at our huddle at the beginning of the day, and we try to involve all the office staff, but mostly it’s just with myself and my MA, you look at each patient and what their needs are going to be, and you try to plan it out.

    Dr. Tom Hastings: Now, not always what you anticipate is what they came in for, and we recognize and understand that, but if they need things like immunizations, or their diabetic metrics brought up to date, or a screening, then we can plan that out. We can say, “Patient A needs a colonoscopy. We need to get that scheduled so she can know that she already needs to do that. They need to be updated on their Pneumovax or their tetanus, so she knows that they already need to do that.” And you do that frequently and often enough, then it also happens automatically, and it doesn’t have to be me entering the order, they’re reminding me or they’re entering the order themselves, which is always good to do.

    Nigel Ohrenstein: Let’s talk a little bit about the MA, right?

    Dr. Tom Hastings: Yes.

    Nigel Ohrenstein: Because what you have done extremely well is how to maximize … Let’s actually broaden it, not just to the MA, but what you’ve done extremely well is how to maximize the team, as you said. So, you’ve got your medical assistant, who, let’s talk about what they do, but then also your scheduler, like, the whole office is part of the delivery of care, which enables you to sort of move up a level and practice at the top of your license.

    Dr. Tom Hastings: [What we try to do, because …] One of the unexpected things that we ran into in other offices that I was at is if somebody was out. So, when I started my own office in 2003, what we decided to do … I was by myself at that time, and we had three different positions. We had somebody answering the phones, we had somebody rooming the patients, and somebody drawing blood. So, those were the three different roles.

    Dr. Tom Hastings: And my three MAs, they would rotate. So, if one was ever out, the other could step in. So, now that we’re a larger office, I’m with a partner now, we adopt that same kind of philosophy, where I work with one MA for a month, Dr. Ganniger works for another MA for a month. We have the blood draw and we have the phone answering. So then we rotate those positions on a regular basis, so everybody knows everybody else’s job. So, anybody can step into anything at any time.

    Dr. Tom Hastings: And what it’s done is, it creates a tremendous work ethic in the office, because, even when somebody’s busy, say, “Can you room a patient for me? Because I’m busy ordering an exercise stress test,” or whatever, they’ll do that, and we use Cisco Jabber in the office because we’re larger now. It used to be, we just holler and everybody pitch in, but now we’re a little bit more electronic with that. And everybody has it up on their screens, and everybody has their computers in front of them throughout your workday, so that we Jabber each other, you know, “Need help here, need help there,” and everybody pitches in.

    Dr. Tom Hastings: At the end of the day, we have a strong ethic, you know, get here early, plan the day, get all the inboxes empty at the beginning of the day, and then work efficiently. If we need extra time, we take that out of the noon hour. But we try to very diligently end on time then, and then finish all our inboxes.

    Dr. Tom Hastings: Now, the key in this kind of workflow is doing work in between when you see patients so nothing accumulates in your inbox to an overwhelming degree. So, we’re always signing our papers as we go through, we always check our inboxes, either the paper inboxes, electronic inboxes, email if we can, but that sometimes will wait until the end of the day, of course. But, in terms of the workflow of the things that need to get done, so that that keeps the work going throughout the day, keeps everybody busy throughout the day, so that, when we’re done, we empty our inboxes and everybody gets out on time.

    Nigel Ohrenstein: Do you round yourself in hospital?

    Dr. Tom Hastings: I do. And the hospital rounding has gotten less and less over the years, for whatever reason. I think we’re doing more as an outpatient now. And the acuity level in the hospital is getting more and more as time has gone on. So, acuity level is greater. Patients appreciate it when they see me, usually. They don’t want to be there and, but they appreciate just looking at … even if it’s not in my field, if it’s some other kind of thing.

    Dr. Tom Hastings: Now, I don’t go to all hospitals. That’s the other thing. I used to go to all hospitals, and, of course, you can’t do that because of all the electronic systems are so different. But, now, I just go to one hospital, but in the others, we try to maintain good communication. And we try. We don’t always make it, but we try to make sure at least we communicate with what’s going on with the patient while they’re in the hospital to make sure we can coordinate.

    Nigel Ohrenstein: So, you brought up the Superbowl. Obviously, as someone originally from Kansas City, you’re happy right now?

    Dr. Tom Hastings: Oh, yeah.

    Nigel Ohrenstein: By the time we air, we’ll know whether you truly were happy or not.

    Nigel Ohrenstein: So, you truly are the quarterback of care for that patient.

    Dr. Tom Hastings: Very much so.

    Nigel Ohrenstein: So, talk a little bit also about the relationship with the specialists. Because you demand different things and more communication from specialists than perhaps the typical primary care physician who’s 100% in fee-for-service.

    Dr. Tom Hastings: The key attributes there, in terms of relationships with specialists, and just like they are with patients, is trust and integrity. I want to refer to specialists that I trust and are of high integrity, and they do what’s appropriate for the patients at the time they need it.

    Dr. Tom Hastings: And getting everybody kind of on the same page in terms of what drives value is very important. So, a lot of times in medicine, we just kind of did a lot because we thought that was better. 35 years of practice has shown better is not always … more is not always better. It’s just not the case.

    Dr. Tom Hastings: So, we always have to focus on what’s best for the patient, especially in the elderly. What’s best for them? What is the ultimate goal of care? And, if it’s helping them be more independent, then it’s of value. If they’re already not independent and they’re suffering or in pain, then the goal needs to be more palliative in terms of providing them better support at the end of life.

    Dr. Tom Hastings: Often, 30 years ago, we just did things because we could without a good view of whether it was really going to change the outcome. So, when we refer to specialists, it’s just with the attitude and the spirit that we want to drive better value care for them.

    Nigel Ohrenstein: Right. That’s great. In fact, I was with the CFO of a health system today, and I was talking about that. When I used to play soccer back in the day, it was how much running could you do up and down, play as much… there was no high-intensity training, there was very little about nutrition, there was very little about … It was just like, run as much as you can, play as much as you can, because then you’ll be better.

    Nigel Ohrenstein: And the context of our conversation was actually about Lumeris. And the value Lumeris brings to the health system today actually is these updated methods, right? That intellectual property. How do you engage a primary care physician and enable them to practice like Dr. Hastings?

    Nigel Ohrenstein: So, for those physicians that are starting off … You’ve been doing this for a while. How do you start? Where do you start? What advice would you give to someone who’s who recognizes that fee-for-service revenue is only going to decline, but I’ve been living in this treadmill, and my infrastructure setup is …

    Nigel Ohrenstein: Where do they start? What are sort of the first couple of steps that you would recommend they do?

    Dr. Tom Hastings: There’s a couple things that pop into my head right off, and, of course, we all have these tapes from our father that rattle around in our brains. But he was always big about, “Education, education, education,” and he was always big about, “Common sense ain’t so common.”

    Dr. Tom Hastings: So, when I think about, “Education, education, education,” it just means that it’s a never-ending process. You are always learning something new. So, just start by recognizing and acknowledging … antithetical to our medical educational system, where we try to develop high esteem in our physicians, so when they come out of training, they think, “Oh, I know everything and I’m ready to practice.”

    Dr. Tom Hastings: No, no, no. Come out humbled and ready to learn. That’s the biggest message I can think of, because it’s all one great big learning process over and over again.

    Dr. Tom Hastings: The other thing is about common sense. It’s focusing on the type of learning that will help make your life easier, improve value of care for your patients, not just here in the office, but in their whole spectrum, in their whole life … Improve relationships with the people you work with, because I think that good relationships with the people you work with translates to better relationships with your patients. If you’ve got a good working relationship in your office, when you walk into see the patient, you’re already coming from a good mindset.

    Dr. Tom Hastings: Read every self-help book you can find. Read a lot about emotional intelligence. The one book I’m reading now is The Power of Vulnerability by Brené Brown. She’s excellent. That’s my next big thing. But there’s lots of very good self-help books. So, I would focus not so much on the scientific… Oh, employ technology to its highest degree. We have more information now, but we’re common-sense poor. So, you have to leverage the communication, leverage the information such that it’s framed and presented in a way that is most helpful to the patient. You can quote statistics, but you can’t quote what’s of value for the person. So, you have to continuously be focused on what’s of value for the person, and be able to articulate that in a way that’s consistent and open.

    Nigel Ohrenstein: That’s amazing. And great advice. Let’s switch topics for a second. You’re part of a broader group, Esse Health, and Esse had the foresight many years ago to start a Medicare Advantage plan, Essence Healthcare, which is, obviously, now part of the Lumeris family of companies, and Lumeris runs Essence Healthcare.

    Nigel Ohrenstein: But take us a little bit back through the history. First of all, my first question would be, like, how did you and your colleagues have the foresight that we needed to start a Medicare Advantage plan? I mean, this is so far before the Affordable Care Act, this is long before anyone was talking about accountable primary care, or population health, or all the jazz words that exist today.

    Nigel Ohrenstein: And it was, to some degree, not too far after so many institutions had lost their shirts in running plans and felt burned by it. So, take us a little bit back in time and talk us through the mindset. Because, I mean, looking back, it was the most amazing decision. I mean, you helped create perhaps the premier Medicare Advantage plan in the country, right? [Averaged] four and a half stars for 10 years in a row, medical loss ratio is great. I mean, it is the epitome of high-quality, efficient delivery of healthcare with five-star patient satisfaction.

    Nigel Ohrenstein: But let’s go back to, what was the thought process?

    Dr. Tom Hastings: We weren’t thinking about any of that. In business, there’s what they call the burning platform. And, for us, the burning platform at the time was, healthcare was a mess. And you can’t change everything, but you can look at your piece and figure out, how can we make this better?
    So, it started with a lot of like-minded primary care physicians that just wanted to contract better, figure out how to work more efficiently, how to get value-based care into the picture. And I think of when we were first really trying to practice evidence-based medicines, Tom Doerr, who was a key intellect in our group who helped drive a lot of the things that we do today, he said it’s all about fidelity to the evidence. I’ll never forget that.

    Dr. Tom Hastings: And so, what we had to do is look at what we were doing and say, “Is this helping or is this hurting? Is this unnecessary or is it necessary? Is it of value or of no value?” And Tom drove that for us. Tom Doerr was a powerful force and a powerful intellect to do the research. And this was before we had things like UpToDate, before we had things like the Johns Hopkins antibiotic guide, and things like that. We were doing things like that, but Tom was doing the research.

    Dr. Tom Hastings: Other doctors, too. I think of other doctors in our group, Stan Vriezelaar really helped us with our electronic medical system. The NextGen, when it came out of the box, wasn’t so good, but we’ve done a lot of work with the templates and it’s much, much improved now. So, it’s a team of people. I think of our leadership, all the people in our leadership today, and how have we evolved over the years.

    Dr. Tom Hastings: So, anyway, have to take a little bit of a backseat to that, because, while I was a driver here and I participated in leadership, but I have to really credit our leadership for that.

    Nigel Ohrenstein: Yeah. I can’t let you mention Tom without sharing … Obviously, for those that don’t know, Tom unexpectedly passed away not too long ago, and enormous impact on my career at Lumeris, as well. And, when you say fidelity to the evidence, when I think of Tom Doerr, I think of integrity.

    Dr. Tom Hastings: Absolutely.

    Nigel Ohrenstein: And that, in many ways, jives with what you said before about integrity and trust with the specialists, integrity and trust with the patient. Incredible influence.

    Dr. Tom Hastings: More important … Well, integrity, obviously, is very important, but his passion. His passion to be a person of integrity. His passion to be a religious person. It kind of pervaded many parts of his life. So, he was really passionate about making sure that we had systems information structure that would help promote better care or less costly care.

    Nigel Ohrenstein: Roll the clock forward. Talk to us a little bit about how critical that Collaborative Payer is, having Essence Healthcare as that Collaborative Payer, as opposed to, we don’t have to name names, but in terms of the experience you’ve had with other payers over the course of time.

    Dr. Tom Hastings: Right. What we value is not an adversarial relationship, but a companion, a value-driven companion. Part of the problem with the way healthcare is structured, 1960s, ’70s, ’80s, today even, is that it’s [in a] adversarial … one person’s profit is another person’s waste. And, as long as that structure exists, then there’s going to be continued antagonism. Unless it can all be in alignment, where everybody is driven to drive less cost, higher quality, then it’s going to be an issue.

    Dr. Tom Hastings: So, a Collaborative Payer model, structured so that everybody benefits from the value that it’s created, and you try to identify value where it happens. We were able early on to identify value in primary care and capture it. But you try to capture the value where the decisions are made. So, that’s just what we tried to do.

    Nigel Ohrenstein: And, as you think about managing populations, you obviously had a decent Medicare Advantage panel size. Talk to us a little bit about Medicare Advantage, and how critical is that as you think about managing population, and the learnings that you’ve picked up from that, and how do you apply that to the other populations that you manage?

    Dr. Tom Hastings: We don’t distinguish, simply because we’re not smart enough. When you’re driving an efficient system, you drive it for the whole practice, you don’t drive it for different segments in the practice. That’d be impossible to do, number one.

    Dr. Tom Hastings: But, number two, it’s freeing. It’s like lightening your load. It’s like, “Okay, if somebody needs an hour, I can spend that hour with them. If they don’t need to be seen, I can treat them over the phone, and they’re happy and I’m happy.” We’re just dipping our toe into telehealth visits. Many visits, people don’t really need to come to the office for, and so we’re trying to identify those low-value visits, when people come in and they’re on their meds, they’re stable. It’s good to maintain relationships, but you can maintain relationships in other ways. So, we’re trying to leverage things.

    Dr. Tom Hastings: So, in the traditional primary care office, it’s all about RVUs, and getting 30 people a day, and staying until 7:00 at night to get all your work done, and you go home, you’re tired, and it affects the rest of your life. So, in a value-driven model where you’re prepaid, you can reorient the work so that it’s much more efficient and everybody’s happy.

    Nigel Ohrenstein: I must admit that I don’t think I’ve yet to meet a physician that hasn’t told me their quality’s excellent, that that they practice excellent medicine. And I’m sure many do. But, by definition, a little over 50% of the population of physicians are below average, right?

    Nigel Ohrenstein: So, talk to us a little about, within Esse, how do you … without … Again, I don’t want any names.

    Dr. Tom Hastings: No, no, no, this is very important.

    Nigel Ohrenstein: But how do you maintain that quality among peers, particularly amongst a population of doctors that are confident in that capabilities, generally speaking? And, also, for the most part, when you are in the exam room, it’s you and the patient, right? When I want to work with my colleagues, even if I say, “Hey, this is the way we should do it,” doesn’t mean we’re going to do it that way. We have to influence each other, we have to get buy-in, we have to collaborate.

    Nigel Ohrenstein: So, how do you maintain quality, as you have done, and improve quality across the Esse Health body of physicians?

    Dr. Tom Hastings: Well, first of all, with great humility. And I’m going to go through a little bit of our quality improvement journey.

    Dr. Tom Hastings: I was with a group long ago that drove this. John Watson had a thing, it was a site that patients would go to, to assess the practice and his performance. And it was as good as CG CAHPS and things like that. “How’s Your Health” was the name of it. It was Ideal Medical Practice and How’s Your Health. And that’s how it kind of got started in, “Oh, my gosh, we can work more efficiently. We don’t need all this space. We can get by with a little bit less.”

    Dr. Tom Hastings: But, anyway, there’s a lot of different attributes that I really enjoyed about the Ideal Medical Practice. And one of the things that was so good about that was, when I came back to my group, on our quality improvement journey, if you will, it came that we were very, very closed. And this is where that power of vulnerability is so important, because we’re all not as good as we think we are.

    Dr. Tom Hastings: And I remember first measuring, and I was like, “Oh, I’m good, I’m good.” Well, no. Dr. Ganniger came and joined me. He’s a little better. But it gets a little competition going, too. And we would tease, because we post our quality improvement results on screens in the back.

    Dr. Tom Hastings: Now, that’s important for a couple of reasons. Number one, it keeps our eye on the ball. It lets our staff know, “Hey, look, this is how we’re being measured. Hey, you didn’t get a hemoglobin A1C on that diabetic. Do you want one?” “Yeah, you bet. We do.” So, again, you have to come from a space of openness, humility, and vulnerability, and with the spirit that everybody just wants to be better.

    Dr. Tom Hastings: So, it’s taken a long time, but we’ve become more and more transparent with offices and names. It used to be, everybody was an A, B, C, D, but what was happening was, people would look at themselves in comparison to others and say, “How are they doing that? How are you doing that?” So, people start looking at the performance of others and start sharing best practices a little bit more openly.

    Dr. Tom Hastings: So, it’s trust. It’s knowing we’re all in this together, we all want to make sure that we’re better. And transparency. But, to get to transparency, you got to have trust, you got to be vulnerable with one another, you got to be open with one another, and you got to want to change.

    Nigel Ohrenstein: So, that’s the quality side of it. One of the things that always impresses me is that you have a handle on the cost side, as well. And you’re often engaging your patient to talk about the cost of care as well as the quality of care.

    Dr. Tom Hastings: Patients are driving that more and more, too. So, we try to take the cost information into the exam room, and that’s really important. So, we have a GoodRx for prescriptions, because everybody’s worried about that. For where to go for different care, people want to know where to go for different care, so we have a matrix we keep in the back. Different insurance will have different copays for inpatient, outpatient, so patients will know how much they have to pay.

    Dr. Tom Hastings: Then, it’s really an exercise that we do in our group frequently through the rearview mirror by looking at our performance quarter to quarter. So, we’re always looking at our performance, where the money goes, how it’s spent, and then how to improve, how to be better with that. Where are costs high, where are our opportunities for improvement?

    Dr. Tom Hastings: So, looking for opportunities to improve in your practice is a constant, ongoing thing. Years ago, it was driving towards generics. Now, as you look at all the price of generic drugs, it’s getting the right generic, because all generics are not priced equally. So, patients really appreciate it, because, you know, Social Security checks only go so far, and everything that I write or do is gouging their social security check, or Medicare, and we just can’t afford that. They can’t afford that. The country can’t afford that. You and I can’t afford that.

    Dr. Tom Hastings: I’m cheap when it comes to my own prescriptions, you know? So, I try to put myself in my patients’ shoes. It’s with great empathy and compassion that I try to always put myself in the patient’s shoes. What do they want? And what is it that they really want? Because they might think they want something, but what they really want might be something completely different. So, getting to that value is important.

    Nigel Ohrenstein: Yeah. One of the things that I think is very interesting to people is not just … We spoke a little bit about how you start as a …

    Dr. Tom Hastings: Yes. Oh, yeah, right. Go back to that.

    Nigel Ohrenstein: … and then a little bit of the progression. So, I remember coming here, must’ve been now about eight years ago, I don’t know if you remember this. Aneesh Chopra was the Chief Technology Officer of the United States at the time.

    Dr. Tom Hastings: I forgot about that, yeah.

    Nigel Ohrenstein: And John Doerr wanted him to come see …

    Dr. Tom Hastings: Come see the practice.

    Nigel Ohrenstein: … come see how a true primary care physician should …

    Dr. Tom Hastings: Value-driven, right.

    Nigel Ohrenstein: … value-driven primary care physician, how he or she should practice. So, that’s already now seven, eight years ago.

    Nigel Ohrenstein: So, what have you done in the last eight years that you would say that, if he were to come back now, he would say, “Oh, these are three things that I do better than I did even back then? And, even then, you, again, would have been my example of an accountable primary care physician. But what are, like, three things in the last sort of seven, eight years that you think a much better than what they were?

    Dr. Tom Hastings: Well, when he visited, the thing that stuck with me the most is, how do we scale this? That just hit me square between the eyes. I mean, I was like a deer in headlights. “I don’t know. You’re the policy guy. How do you scale this?”

    Dr. Tom Hastings: But it got me thinking a lot about that, and it got our group thinking a lot about that. So, number one is doing what I’m doing right now. Sharing what we do. We’ve started a new company within our group to try to help other groups perform better in a value-based world. So, we’re trying to share the methods more freely than we have in the past, so that others can learn from our mistakes and experiences.

    Dr. Tom Hastings: But the truth be told is, it’s all about culture. It’s all about culture. Just getting the right culture. So, how do you share that? And it takes a long time to develop the right culture… and it’s still an ongoing process in our own group. It just never stops.

    Nigel Ohrenstein: Which is truly amazing, and I use it as an example all the time when … As you know, Lumeris is focused on enabling health systems to move to value-based care. And, obviously, we’re working both with the employed physicians as well as the affiliated physicians. And I actually use the example of … without the name, but I use the example that you just gave all the time, which is, even in our highest performing groups that we’ve worked with for over a decade, there’s always opportunity and remains opportunity to improve and get better.

    Nigel Ohrenstein: And it sounds like it should be obvious, because in every sphere of life, we’ve always got areas to improve and get better. But it’s amazing that even the highest performing physicians have that opportunity, as well as a group, there’s always opportunities.

    Dr. Tom Hastings: Well, there’s a thing called Choosing Wisely. I’m in the Business Healthcare Coalition. This is the other thing I did. Well actually, I got more active in the Business Healthcare Coalition. So, when Aneesh Chopra says, “How do we scale this?,” I said, “Well, I got to understand what the concerns are for employers and what they’re doing to address their issues.” So, I was trying to make a better study of the payers in general, so that we have a better understanding and can partner better. Because we all want better care for our employees and our loved ones. They’re our family.

    Nigel Ohrenstein: Yeah, absolutely.

    Dr. Tom Hastings: So, it’s important.

    Nigel Ohrenstein: So, I always like to end with a couple of quick-fire questions. So, best piece of advice you’ve ever received?

    Dr. Tom Hastings: Never stop learning.

    Nigel Ohrenstein: That’s a great one. What’s the first thing or one of the first things you tell new patients your first time you’re interacting with them?

    Dr. Tom Hastings: I try to let them know everything about the office, and it’s all about education. The more they know about their disease process and what works and what doesn’t to treat that, the better they’ll comply. If I can make a good value proposition to them, this is the reason why they need to take their hypertensives, they’ll take it. And, if they don’t, they won’t.

    Dr. Tom Hastings: And I always try to, more and more, and this is an exercise that I fail at … Well, let’s put it this way, I failed way too frequently before, is, I didn’t know what they valued. So, I’m trying really, really hard to listen much better now to figure out what they value, what they want, what are their goals for their care.

    Nigel Ohrenstein: And, finally, if there’s one thing about healthcare you could change, what would that be?

    Dr. Tom Hastings: If I could snap my finger and be like Harry Potter or … Often, I say with patients, I’m in a Star Trek world, and if there’s something I can’t really do much about, I take my otoscope and I put over them and I go [Star Trek Medical Tricorder Sound]… You know, like they do on Star Trek, make it all better?

    Dr. Tom Hastings: So, there’s certain things that I would just love to just snap and make better. If I could snap my finger, I would change the medical education system and the payment system all at the same time. I would change the culture of medical education in the Country and I would change how physicians are paid for their work. I would do that in a nanosecond.

    Nigel Ohrenstein: Tom, thank you so much. I could actually sit and chat to you for hours. And what strikes me every time I have an opportunity to sit with you is, I always learn something new. So, thanks for inviting us into your office …

    Dr. Tom Hastings: Thanks for coming.

    Nigel Ohrenstein: … and thanks for taking the time to chat to us today.

    Dr. Tom Hastings: No, I appreciate it.

    Nigel Ohrenstein: Thank you for joining us today. Don’t forget to follow us on your favorite streamer, SoundCloud, Spotify, or Apple Podcasts. In addition, please rate us, and if you’d like more information about Lumeris, please go to

    Nigel Ohrenstein: Join us next time on Tuning Healthcare.

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