Tuning Healthcare, Episode 16: Driving Healthcare Transformation through Data, Diversity and Health Equality

Renee DeSilva, Chief Executive Officer, The Health Management Academy

This episode of Tuning Healthcare features Renee DeSilva, the CEO of the Health Management Academy. She previously served as executive vice-president and chief talent officer at EAB and senior vice president of sales and marketing at The Advisory Board. Renee also serves on the board of Inova Health System and leads the Mosaic Network, a joint venture project to expand the number of board level roles in health care companies for people of color.

Renee DeSilva discusses The Academy’s role as a major industry convener and shares insights from their alliances with health systems driving transformation.

“I know that there’s a commitment to looking at the data in a way that is representative of the whole community. I’m seeing some of our more innovative members standing up equity committees of the board and ensuring that every quality metric and every workforce metric is cut by race, ethnicity, primary language spoken and sexual orientation.”– Renee DeSilva, Chief Executive Officer, The Health Management Academy

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

• Using data to improve health equality and the efforts to increase diversity within boardrooms across the healthcare industry
• The unprecedented opportunity for health systems to lead the transformation of healthcare
• How the Academy has maintained a leadership role during the pandemic and key issues they are addressing with health systems CEOs
• Reasons why fee for value is the best opportunity to drive a transformational healthcare system
• The current industry trends poised to become part of the healthcare landscape and those likely to wane

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• Read Transcript Below:

  Nigel Ohrenstein:  I’m joined today by Renee DeSilva, the CEO of the Health Management Academy. Prior to joining the Academy, Renee served as executive vice-president and chief talent officer at EAB and senior vice president of sales and marketing at The Advisory Board. Renee serves on the board of Inova Health System and is a passionate advocate for health equity. Renee leads the Mosaic Network, a joint venture project to boost the number of people of color in board level roles in health care companies. In this episode of Tuning Healthcare, Renee and I discuss health equality and how she is both working to drive the diversity into the boardroom and also use data to improve health equity. How she transformed and led the Academy through the pandemic, an organization that prior to COVID had 65 in-person meetings a year, the key issues she’s hearing from CEOs of health systems, and in particular how they tackle workforce issues and the opportunity for health systems to lead in the transformation of healthcare. Join Renee and me as we tune health care.

  Nigel Ohrenstein:  Great. Renee, thank you so much for joining us today. It’s really a pleasure to have you with us not only for your own role and your own perspectives, but also given the Academy’s role and the perspectives that you share and understand from so many of your members is going to be really fascinating for us to hear. So, before we jump into sort of health care and the issues facing our industry, tell us a little bit about your background and how did you end up in healthcare?

  Renee DeSilva:  Yes. Well first thank you so much for inviting me. I’m really happy to have our conversation today. So in terms of background, I am from Rhode Island, which is a very small community and spent all of my life there, ended up getting into healthcare, somewhat accidentally, which I think is how many of our career paths go. They tend to not be so linear. So after graduating from Syracuse, I joined Accenture, loved that work, was actually focusing on consumer products at the time and began to develop a pretty good technical acumen. 

  Renee DeSilva:  And then I woke up one day and realized that I actually like to talk to people, and my sort of personality tends to be a bit more extroverted. I wanted to relocate from Rhode Island. And so I looked at opportunities within the DC Metro area and came upon this at the time, a small company at the Watergate in Washington, DC called The Advisory Board, and that is where I got my first introduction to healthcare -which has been a now 20 plus career path. But it started with going out and meeting with hospital executives one by one and learning the story of healthcare from the lens of an administrator in a local market.

  Nigel Ohrenstein:  And at The Advisory Board, did that sort of cement your interest in health care or was there a particular event or was it just sort of this continuation of working in healthcare and that sort of became your path.

  Renee DeSilva:  I think you get an appreciation for the complexity of healthcare, the importance of it from a mission perspective, both in terms of how you deliver on the needs of the community and the fact that it’s such a major employer. And what I think kept me in it, was the complexity meant you could really never become an expert because the breadth and depth is so significant. And I was able to learn different elements. If I started off on maybe an operational project, I could then go into something that may have been more strategic in nature. I think that is what cemented the interest and kept me engaged in it for my entire career.

  Nigel Ohrenstein:  That’s great. And so I think it’s about three years now since you, maybe a little longer, that you took over the reigns of the Academy. And I must admit from my perspective, I think you run the best events, they’re substantive, they’re small, so that you can have, engaging conversation. You have sort of a who’s who list of members. But what was your impetus for taking that role and sort of furthering the Academy as a sort of a platform for a healthcare engagement?

  Renee DeSilva:  Yeah. So I’m about three, almost three years into my tenure. I would say the reason why I took the role, was because I think the platform and the folks that we engage have the ability to transform the industry. So if I could describe us, I would say the core of who we are… And I agree, I think our meetings are fabulous. It doesn’t hurt that we get to go to such wonderful places with our members a couple of times a year… But I would say the core of who we are is we are a convener. We bring together peers in network to really talk about issues that are impacting the industry. And I think that platform of chatting with the largest health systems across the country and the industry organizations that are a key part of that transformation was the initial draw.

  Renee DeSilva:  And then as I think about where we can continue to extend our reach and have an impact with our core is peer-based networks, leadership development, and convening, we are now trying to say, “Okay, how do you take all of those insights that we’re hearing from our members and package them in a way to be much more of an insights generator and the ability to drive the industry forward in an asynchronous way?” And then the third piece that I think we can activate on would be just, how do you then animate around strategic partnerships and alliances that have the potential to even do that on steroids? And so I came because the platform and I could see the potential of extending our impact and I think through the COVID experience that we’ve all gone through, I think we’re much clearer in how that could actually play out. 

  Nigel Ohrenstein:  So tell a little bit about those alliances. When you say partnerships and alliances what comes top of mind to you?

  Renee DeSilva:  So, I think the one that is most salient right now would be as we have seen through COVID, that the gaps in health equity are at an all-time high right. And that has shown a spotlight on an issue that I think we all knew existed. I think the Alliance that we’re building now around health equity is bringing together large providers, industry organizations, potentially some not-for-profits that could come to the table and really think through if at scale we wanted to continue to really make progress on health equity. How would you do that in a way where you bring together the power of the larger ecosystem to move that? So that would be one example of an Alliance that we’re currently building.

  Nigel Ohrenstein:  So, I’m passionate also about the inequality of healthcare in this country and mentioned it, I think already a couple of times on this podcast that I live in the Bronx and one and a half miles away from Manhattan. And there’s a five-year difference in longevity of life between the Bronx and Manhattan, which is just crazy when you think it’s literally a mile difference. And so I know you’ve involved with Mosaic Network and other things around health equity. Tell us a little bit about Mosaic and then also I’d love to delve into what could we do more around driving health equality, and what would you like to see from your member organizations who obviously can play a massive role in helping to solve this problem that we have all across America.

  Renee DeSilva:  Certainly. So Mosaic, the mission of that organization, this will be a 501(c)(4) that the Academy co-founds along with Welsh Carson, Oxeon, and Town Hall Ventures and the thesis-

  Nigel Ohrenstein:  A path for growth.

  Renee DeSilva:  Yes, a good group, and again we’ll build bridges with other organizations as well, but this is really around the representation part of the DE&I agenda. And our premise there is that we know that there’s a lack of Black and Brown executives in board roles. And my personal perspective is that it’s less about the readiness of the executive. There’s an issue with the talent being less visible. And so, the purpose of Mosaic is to bring together private equity venture, other healthcare companies who are committed to board level diversification with a talent pool that is ready to serve. And so I think the way that, that connects back then to the equity and outcomes piece of it is we know that if you have people around the table with a different lived experience, they will ask the questions and we’ll have a perspective that would be important to represent.

  Renee DeSilva:  And so I think if you look at how as an industry we really want to impact outcomes, it is both in the decision-making body, both operational leaders and directors and folks that are in governance positions being committed to it. And I think that senior level commitment is important. And then on the ground, in terms of what we’d want to see from the broader community, I think there’s a lot to unpack there, which I’m happy to elaborate on, but let me just sort of pause for a second and say, I do think a key part of it is, better representation in senior level roles as an important catalyzer for driving through equity outcomes at scale.

  Nigel Ohrenstein:  I couldn’t agree with you more. And so let’s delve into some of the things that we could do on the ground. So if you’re gathering a group of executives, as I’m sure you will as you get back together, and this will be a topic you discuss. What are some of the things that a health system executive listening now could and should be doing that perhaps their organizations are not doing as well as we would like them to do?

  Renee DeSilva:  Yeah. So maybe I’ll answer that by sharing the things that I’m noting that I think are a really good start. So, I know that there’s a commitment to looking at the data in a way that is representative of the whole community. And I’m seeing some of our more innovative members standing up equity committees of the board and ensuring that every quality metric, every workforce metric is cut by race, ethnicity, primary language spoken and sexual orientation. And so I think just the mining the gaps in the data is a big part of how you would activate around a strategy.

  Renee DeSilva:  I would also add, I’ve been impressed to see, and this gets back to where we started with Mosaic, but many of our members are using established employee resource groups to understand the needs and the community at a level that would be different than a leader who’s inside the organization’s ability to do it. So, a great example of that would be Yale, New Haven has done some really great work around greater diversification on clinical trials. They did that through bridge-building with the AME Zion Church in the new Haven market, as well as a Latino organization that is local to Yale, New Haven as well, or local to New Haven as well. So, I think it’s taking your internal folks and figuring out how to activate those into the community around the gaps that your data indicates is a good place to start.

  Nigel Ohrenstein:  Yeah, I think that’s critical. Funny enough, I was having a conversation yesterday with a friend who is vaccinated, a member of the Black community. And she shared there’s just fear. There’s fear among her friends and family that because of the inequality that’s existed for years, that the vaccine might not be the same as the one being administered elsewhere, that any other different fears that come into it. And so we had that exact same conversation around how do we use her church as a sort of a ground to educate, to build trust, and so we had the conversation a while ago. We had it again yesterday and now her church has recently started vaccinating on-site and that’s made a massive difference to sort of trust and belief and there are clearly barriers that need to be amended as well as it’s not just about driving a mobile unit into different communities and that, that’s good, but it seems that’s insufficient.

  Renee DeSilva:  That’s right. Yeah. I think your sentiment around there have been instances historically where trust has been broken and the way that you rebuild that will have to be from working within communities that have already created and engender that trust. And I think many of our providers are really leaning into that in a way that I think is important.

  Nigel Ohrenstein:  Right. So let’s switch back to the Academy for a second. And so I’ve been a fascinated observer of leadership during the last year, and I’ve seen leaders that are paralyzed and doing things that sometimes seem really crazy because they’ve been paralyzed and then they feel like, “Oh, I need to act.” And then they act, and it sometimes doesn’t make sense. And then you’ve seen, and we’ve seen some unbelievable leaders who have managed to maintain calm and yet continue to drive a strategic agenda pivot when necessary. 

  Nigel Ohrenstein:  So let’s start first with the Academy itself. The 65 in-person meetings. You couldn’t have written a script that was more potentially harming. I don’t think you could have done scenario planning in any strategic planning process that would have, someone would have said, “What happens if we can’t do any meetings in person?” And so start with the Academy, you clearly led the Academy incredibly well through the last year. Tell us how you did that and sort of what was the inspiration for you as you went through that process?

  Renee DeSilva:  Yes, I would agree. It was a bad time to be leading a company that produces 65 live events a year in the middle of a pandemic. So I agree. I think our motivation was, so take the meetings aside. What is our mission? Our mission is to really put members at the center of all that we do. And what we recognized at that time, particularly in the early days was that, there was a huge need to fast cycle learnings and to be a really agile learning organization. And so we just pivoted our model to be able to meet our members where they were and just help them information share in a way that would allow them… I mean, it was very simple things in the beginning like how do you think about your workforce policies in the midst of COVID? How are you standing up? What does a good command center structure look like? And who’s running it? 

  Renee DeSilva:  So the first thing was serve members, and I think our team is very wired to do that. And so we started by just making, having and all that come together. So for us, the pivot was virtual. I think we did it in a way that still felt true to our roots, which felt small and curated around the virtual table at that time. And really tried to be valuable in the moment. It also, and I’ve noted this from our members, strong member leaders too. It was also a chance for us to figure out what parts of our business needed to adapt. And so one of the things that many of our members would often give us feedback on was, we had great sessions in the moment but all of that insight was left on the cutting room floor. It was just left in the room.

  Renee DeSilva:  And so part of what we’ve done is we launched a set of services and tried to add value by just packaging the insight to support asynchronous learning, given how busy people were. And that now will become a standalone offering that we provide, because we think there’s value in that. So I think those are the two things, rapid cycle learning, facilitating it, and then really doubling down on our own ability to package and share that insight out in asynchronous ways as broadly as possible. And I would say also making sure that we were very clear on what the value was to each individual member and having a number of calls and making sure that we were meeting people where they were, and that would include our industry and our health system members alike.

  Nigel Ohrenstein:  So as any great leader, you’ve obviously focused on your customer and how you can help and how you did help your customer. Tell us a little bit also about how you helped your own employees through it, because one of the things that I think is striking about your leadership is that you do it with sort of compassion. In sort of combination with the drive for excellence. And so you’ve obviously got to serve your members, but at the same time you have an employee force that was gathering in person 65 times a year. Okay. They don’t all go to every event, but you get the gist. And so how did you? What sort of some of the challenges you had with your own employees and how did you overcome those?

  Renee DeSilva:  Yeah. So, I would say we asked a lot from them. So, the pivot from 65 live events turned into 300 virtual events and the level of orchestration required to execute on that was not insignificant. And it tends to be not quite as fun, because it’s higher volume and there’s a lot of administrivia and the details around that. And so I think that was… We just required a lot of them. I think for me, the piece that we really work hard to do and would just be to really frequent communication, trying to attach how this really still is very much missions, a member at the center and every interaction, trying to make sure that they tracked with that. And then I think probably most importantly, and this has been a learning for me as I’ve matured in my own leadership is just admitting, just taking things off the table.

  Renee DeSilva:  And just even myself coming to a session saying, “Guys, this has been like a tough week and I just don’t have the energy that I normally have.” And so just giving permission for it to not always be all good. And sometimes you’re having, you’re struggling. Many of us are caretakers. I myself have three children. And so you’re also trying to manage school situations and a very full house. And so I think what we really tried to do was make it okay to not always be okay, and still having to serve the needs of the member, but creating space for folks just to take a breath when possible. 

  Renee DeSilva:  And doing that tactically, it’s one thing to say it but then it’s… We implemented a number of what we just called team out days where people could just take the time that they needed. We did a lot more around sort of summer Fridays. I’m now implementing a no Zoom Friday rule, because I think now it’s been just the video just becomes the challenge. So, I just think it’s trying to dial up your empathy, being comfortable, being vulnerable yourself and trying to focus on what’s important. And in some ways taking some things off the table is generally how I’ve tried to approach it.

  Nigel Ohrenstein:  Yeah so we have a mantra around our organization, which is if everything is equally important, everything is equally unimportant. And so prioritizing is always critical. And I couldn’t agree with you more in this world. The other thing that I thought was fascinating, which there’s an article recently in the wall street journal by the new CEO of UPS and she was teaching her organization to say no, to say, these are things that we can’t do, because they also have obviously a service culture and in a service culture, you always want to say yes, and sometimes that’s not good for the customer, if you’re not the right person to be serving that customer. And obviously that’s not good for your organization. So it’s a fascinating article about teaching an organization to say no, which is perhaps more important now than ever.

  Renee DeSilva:  I agree. I have to look at that. That’s great. 

  Nigel Ohrenstein:  So, one of the things you mentioned as you talked about the transition through the pandemic was sort of the new table. And so I know you’ve got your new podcast, well, the new season of your podcast, which you’re calling The Academy Table, which it sounds like a fantastic name. I can guess what the meaning of it is, but I’d love you to share sort of the meaning of the table. And also, I think this might be the first time that we’ve had a guest on the podcast that’s also the host of another podcast, so that’s a first as well. So, we’re excited to hear your podcast. And so tell us about The Academy Table.

  Renee DeSilva:  Sure. And Nigel I’m taking notes too on what I can learn from you, because it sounds like you’ve done at least 20 more recordings that I’ve done. So I’m learning as we chat. So for me the name, The Table, two reasons for that. One is it’s really core to who we are as an organization. We curate tables and we drive interesting conversations. And I think the podcast is another format for that. And then I do think back to where we started our conversation, there is a national dialogue around the importance of having new voices represented and making space at the table and making them feel more included at the table. 

  Renee DeSilva:  And so I do hope that I can have that niche of, I want folks to hear from people that we all know, but I also want to invite people who have interesting perspectives that you may not have heard of. And so that’s the other piece of it. And then just fun. If I think about what I miss most from COVID is just that sitting around the table with my girlfriends, having a glass of wine and just catching up. And so I hope that, that’s what we’re able to accomplish through our new season of the Academy’s podcast.

  Nigel Ohrenstein:  No, I love the image of it. And so similarly for us, our dining room table has always been a source of great conversation, a source of great entertainment. We host lots of people around the dining table. So I’ve got this image of you hosting a table of like eight people and it’s going to be a podcast as we, when we can get back together and you can have this conversation, dynamic conversation going on in your podcast and capture this dynamic table conversation that I think we all miss enormously. The good news also, I would say for the Academy, at least from my perspective and from people I speak to is that there’s a thirst to get back together. And maybe there are many things that we did in person that we now know we can do remotely, but there’s enormous number of things that we can’t. And so I’m confident you’ll see people come back together pretty rapidly.

  Renee DeSilva:  I think that’s right. People miss just the casual sidebars that you can’t accomplish via zoom and just the coffee table chats, I think people are hungry for. So, I agree with that.

  Nigel Ohrenstein:  Yeah. That’s actually what I miss the most. It’s actually not the meeting itself, but it’s the 10 minutes before and the 10 minutes after. I miss that enormously. Those were my favorite often my favorite part of interacting with people on the road.

  Nigel Ohrenstein:  So, one of the things that I think is fascinating about your role is that you interact with so many different leaders and organizations across the healthcare spectrum rates and across the country within lots of different types of health systems. So, what are you seeing and hearing from your member organizations right now, and does that differ by type of organization? Does it differ by role? What are you hearing and seeing? What are the top things that are concerning to your members right now?

  Renee DeSilva:  Sure. Maybe I’ll start by channeling what I’m hearing in our CEO conversations, because I do spend a lot of time with that constituency directly. So I would say for the most part, they feel like they have packaged and learned the lessons from COVID and are really eager to have a much more future-focused lens. And so many of the conversations tend to be, “How might I think about the healthcare landscape with a broader aperture five, 10 years out, and what will be the forces animating with that time horizon that I need to be thoughtful about now.” And so where that generally goes in terms of what does that mean practically? Significant interest in chatting about all of the workforce issues. And it’s really two parts on that. Part one is the culture and how do I meet my 35, a hundred thousand, sometimes larger workforces where they are.

  Renee DeSilva:  So where will work be conducted? What will be the demand for continuing to stay virtual in some settings? How do I think about redesigning care delivery teams to be mindful of how these shifts have to happen? How do I lead from the middle? So, one of the other things that we’ve all seen is in this period of time, there’s such polarized views on both ends and CEOs are being asked to sometimes hold a position. And how do you really think about that as leaders, national leaders and really big regional leader? So, I think all of the workforce pieces are in there, not to mention margins are still under pressure. Reimbursement will never be higher than it is. And so what does that then mean around, how do I need to think about efficiencies and trade-offs and taking expense out, given that workforce represents probably 55% of overall labor, overall expenses.

  Renee DeSilva:  And so I think a lot of issues around workforce activation come up. I do think this transformation, how do I think about structuring my assets appropriately? Omni-Channel, what’s the mix of, obviously I have heavy physical infrastructure, but how do I pepper in the more access friendly, more consumer-friendly points of the health care landscape that comes up a ton? And maybe the third I would say, and I actually would love your take on this too, would be systemness, and so we’ve talked about that for as long as I can remember. I think this pandemic has really proven that if you’re not operating as a true operating system, if you still have any holding company DNA in you, it’s going to be really hard to be successful. And so I do think this notion of how do I synchronize across large regions and sometimes multiple states is top of mind for that group as well. 

  Nigel Ohrenstein:  Yeah so I think that’s true across lots of different organizations that SILOs will suffer perhaps more than ever in a post pandemic world and as health systems, I think that there’s that balance between bringing the capabilities and the structure and the quality of sort of a larger organization, but yet recognizing the needs of the locale in which you operate and even within a health system there can be stacked differences between often the mothership that tends to be in a more urban setting and some of the local hospitals that tend to be more rural and so understanding and continuing to get that mix right I think is going to be critically important to health systems as they move forward.

  Nigel Ohrenstein:  What are you seeing in terms of sort of the transformation piece. We’re seeing increasing number of health system execs saying because of those two dynamics you just mentioned, margins continuing under pressure, reimbursement never being higher. We’re seeing an increasing number of execs say, “I need to move faster to value based payments because that will protect my revenue.” And in an era where I knew that was coming, but I see that now coming faster, are you saying something similar or are you just seeing that I’ve got so many other things to deal with now that I really just have to push that off. 

  Renee DeSilva:  No. I think the vulnerability of a fee for service model definitely came through in terms of the COVID experience. We track this closely. I’d love any of your recent data on it. I do think there is many will mention that they need to do more. They need to accelerate. They need to figure out how to move that needle. Are they doing it with enough urgency? I’m not sure.

  Nigel Ohrenstein:  Right, so there’s something that’s something that actually keeps me up at night, because Lumeris is all about the health system. We believe the health system is absolutely critical component in the delivery of health care. It’s not going to go away. It can’t go away. It serves the largest number of people more than any other sort of sector of the healthcare industry. It interacts. It’s the most trusted brand in the market. It is best placed to be the leader of health care transformation. But what worries me enormously is that too many leaders are not moving fast enough and that the payers are going to continue to do what the payers need to do to protect their business model. They’re a little bit more cutthroat.

  Nigel Ohrenstein:  And I don’t actually mean that in a bad way. I mean that in a way of the people that look after that business model. And people often think of looking up to a business model as a negative term, but really that’s looking after your employees and looking after your shareholders and that’s the responsible thing to do in many ways. And so I worry that the health systems are not moving fast enough and are a little bit shy to make some of the critical decisions that they need to make.

  Renee DeSilva:  Yeah, I think that’s probably fair. I think it comes down to the business model and what your current, you’re in year or next couple of year balance sheet is sort of anchored on. And I think that probably makes it a little bit harder. I’m just thinking back when we look at the different metrics that folks are tracking in terms of whether it’s at the board level or just management, it tends to be some of the traditional metrics that would probably have not changed across 10 years. So I think it’s probably fair to say that perhaps there needs to be another wave of this that I do think there’s greater appetite given where we are now as a country, but I think there’s still some momentum to be built is my sense.

  Nigel Ohrenstein:  Right, so we’re seeing a lot of trends that have been accelerated through the pandemic. Obviously tele-health exploded. It’s gone down again recently, but still way above what it was pre-pandemic, home health, just given all the things that we’ve discussed even today, the need for behavioral health is more acute than ever, not just in terms of the health equality that we spoke about, but just all the different things that we’ve touched on have behavioral and mental health implications. So, which of these trends that we’re sort of seeing accelerate in healthcare do you think are going to sort of be boomerangs and we’re going to go straight back to the way we were before? And which do you think will be frisbees that trends that we’ll see grow and be really sort of fundamental to how health care and health systems operates moving forward.

  Renee DeSilva:  I love this question. I’m a little bit worried that the virtual health will feel a bit more like a boomerang than we all might like. Yes. Better than where we were pre-pandemic, but probably not necessarily as anchored into the DNA as we might like. There are certainly some systems that are exceptions to this, but I think it’s still pretty hard to navigate. It certainly is nothing close to what you’d get from some vendors that are, that’s their core business model. And so I do think maybe some backsliding on physician adoption and just how it fits in the broader realm of things is important. 

  Renee DeSilva:  What will the regulatory and reimbursement environment look like if that doesn’t stick, then I think there’s some risk there. In terms of your frisbee, I do think this agility and this now acknowledgement that they can make progress much faster than they anticipated is going to stick. So I note that. I think there is a greater urgency around all things because they did see how, when they had to maximize virtual health as an example, they were able to figure out all the reasons why it previously couldn’t work. When they had to really accelerate on their supply chain, they figured that out. So, I do think this agility more rapid decision-making, operating more agile, not holding sacred cows. I do think that is going to be a trend that we continue to see.

  Nigel Ohrenstein:  I think the not holding sacred cows is perhaps one of the most important business lessons that I ever received early on in my career. And I’ve always told my team right. If the reason to do something is because we did it yesterday, that is a really bad reason. And so come back with another one, right?

  Renee DeSilva:  That’s right.

  Nigel Ohrenstein:  Because we need to have… It just hampers growth. And that’s definitely a challenge. And so as you look out to your role, you obviously have an amazing platform to not just interact and get the feedback from your member organizations, but also to influence how they think about these topics. What is sort of, as you think about putting back together the first CEO forum that you pull back together, what would be like the top couple of topics that you expect to be on the agenda?

  Renee DeSilva:  Yeah, I definitely think this notion of what are the major forces shifting us and what is our own predictions as to how transformative that will be, will be a big part of the conversation and getting input from them directly. And just doing a little bit of the gap assessment of do we believe differently, based upon our prototype or archetype. So, if I’m all in on fee for service versus I have really adopted a pop health strategy, I might feel differently about it. So a little bit of heat and debate around that, I think would be good. I do think this notion of scale and what are the benefits of scale, and then the maybe counter argument to that would be to think about where disruption has happened in other industries, it’s more been where you were not encumbered by scale. You could be more agile.

  Renee DeSilva:  So, if you think about FinTech and other innovations there, it’s sort of, or even the Ubers and Lyfts of the world, they sort of ran counter to scale. So, I think this debate around what is big enough and how do we think about that will definitely be top of mind. Consumer is a big one. This is an area to where your earlier question around, is there urgency around issues? So, we did a survey recently where I think there was 80% alignment around becoming more agile and easier for consumers was… Everybody agreed with that. And evaluation of our performance against that metric, a really big gap between important, critical, and our performance was a really wide gap. And so I want it like, what’s the right way to move that conversation? It’s not a new conversation, but it’s one that needs I think a new lens to it. So those are a few flavors. I don’t know, what am I missing? What would you add?

  Nigel Ohrenstein:  So, I think you’ve hit most of them. I think that last one is one in particular that I’m enormously passionate about. It literally drives me nuts and we’ve discussed it on a number of these podcasts that the consumer experience in healthcare continues to be for the most part unacceptable. And we all talk about patient centered care, but we really continue to have physician centric care. And the experience we get going into Nordstrom or a Marriott hotel or anything that we do in the normal course of our lives, our normal lives pre-pandemic, the experience we get is very different to the experience we have when we interact with the healthcare system. I think that’s an unbelievable opportunity for the health system to take the lead in driving true consumer behavior, even the most basic things like I show up to the doctor and they have in a convenient Excel spreadsheet to start, they have, “Nigel, great to see you last time I noticed you like lemon tea. Can I get you a lemon tea?”

  Nigel Ohrenstein:  Just that one little thing that can be kept on a spreadsheet would be transformational in terms of how I think about and interact with that office. And in terms of driving stickiness and terms of… And ultimately driving better health care because I think that will… A better consumer environment will lead to a more compliant consumer which is part of the healthcare equation. So I think that’s a critical one. I think it’s, putting a Lumeris lens on it, it’s I think the question is we’re seeing an uptake in the pace at which people want to move to value based care. I think it’s… I would be interested in understanding how the health systems see that. How do they differ by, by sort of the environment in which they operate and then tied to that, how do they really de-risk that move? How do they do it in a way that enables them to not put the sort of the core at risk? 

  Nigel Ohrenstein:  And there’s obviously a great buck crossing the chasm, which is so critical to understanding how you move business models from one to the other, but how do they do that in a way that enables them to maintain sort of the core business, but drive transformation at a higher rate, because as we discussed earlier, it worries me that others… There’re a lot of forces. Not just the payers, the independent primary care practices, there are a lot of forces that are not favoring the health system right now, government regulation move. So, I think the fee for service train ended a long time ago in terms of its future.

  Nigel Ohrenstein:  We’re still running the old models and those are going to continue to run for a number of years, but the fee for value chain is the future. And you have to, the quicker you adopt it and the quicker you understand what you need to be successful in it, the better those health systems will be, but we remain passionate that they are the core and have the best opportunity to drive a really transformational healthcare system in this country. 

  Renee DeSilva:  I think that’s right. 

  Nigel Ohrenstein:  So we’d like to end with what we call the quick-fire rounds. And so what’s the best piece of advice you were ever given?

  Renee DeSilva:  That I was ever given?

  Nigel Ohrenstein:  Business advice, I guess, or you can… Whatever type of advice you want. Could be any.

  Renee DeSilva:  Yeah. I was going to go to, this goes back to the leadership piece of, it was a former boss took me to the side and said that I needed to work on how my vulnerability came across. That I sometimes just came across as just having, just being too much of a glass shield in front of me. And people can’t relate to you if they feel that you don’t get them, then it’s going to be really hard for you to create a following and if people want to work with you. And that I remember it stinging at the time, but I do think it really shifted how I try to show up. And that probably was the single piece of advice that I’ve gotten that has stuck with me

  Nigel Ohrenstein:  The best advice, often dusting and it hurts.

  Renee DeSilva:  It hurts yeah. I always say to my team, feedback is a gift, but you might not always like it, but yes, that is so true.

  Nigel Ohrenstein:  As long as you internalize it later, that’s all that matters. What do you do to relax have fun?

  Renee DeSilva:  I mentioned I have three kids and they’re all into athletics and I turn into a different person on the sideline of any kid’s sporting event. And so for me, that is where I’m in the moment. I’m not thinking about what needs to happen at work. I’m just totally plugged in. And so whether it’s my two daughters who play volleyball, or my son who plays basketball, that is definitely my happy place. And it’s starting to come back. So we had our first travel tournament last week and it made me, it made my heart happy.

  Nigel Ohrenstein:  Yeah, I know sport is an amazing learning ground for business in many ways. 

  Renee DeSilva:  It is. I love to hire athletes because I think if you can learn how to win and lose gracefully and just the balance that it takes, it typically serves you well throughout life.

  Nigel Ohrenstein:  So I know this is supposed to be the quickfire round, but I hope you’re not one of those parents that I first met the first time I came to America and I played sport to a pretty high level. But when I first came to America, I went to my nephew’s Little League game when he was like three, maybe four. I’m talking like there wasn’t a kid with ability to make the pros with anywhere within sight and the swearing and aggressiveness of the parent body on the side just shocked me. 

  Renee DeSilva:  That’s crazy. Yeah.

  Nigel Ohrenstein:  I’d never seen anything like that. And as I say, I played pretty high level, but the parents were… I’d never seen anything like that. So I’m hoping that, that’s not Renee on the side.

  Renee DeSilva:  I don’t I think so. But if you think that’s that, go to an AAU travel basketball game and you haven’t seen anything until you’ve seen that? No, I’m not a complainer. I’m just a very loud cheerer.

  Nigel Ohrenstein:  Right. Well, that’s good. That’s what you should be, particularly for your kids. What advice would you give to your younger self?

  Renee DeSilva:  Oh, I tell her sister, just take a breath, be willing to take some risks. It’s okay if you don’t get everything right, you can fail along the way. I think we all hold ourselves to a high standard and most of the time that’s good, but sometimes it can be a little bit counterproductive, so.

  Nigel Ohrenstein:  Right. That’s good advice. And then if you could change one thing about health care, what would it be?

  Renee DeSilva:  Just one thing? And let me just close with a story. This actually happened yesterday. I was chatting with a friend who had a baby born with a rare cancer last March. And he is in healthcare 20 years, is very savvy on how to navigate the healthcare system. And the conversation was, “I don’t, for someone as informed as I am with means and money to sort of subsidize this. It has been a nightmare, not just the diagnosis, but the nightmare of navigating her care path through what is probably one of the most devastating things that could happen to you.” And so I think we can do better as a country to help navigate and meet people in their biggest moments. And so I think if we could figure that out, how to work with people at that time, that would be, I think we would all feel better about the industry.

  Nigel Ohrenstein:  Right. That’s so true. Renee, thank you so much for, for joining us today. It’s just incredible to hear your perspectives. It’s inspiring to be and learn from a leader who transformed an organization that was so reliant on in-person. And I’ve got such great confidence coming out of the pandemic that through your leadership, the Academy will not only thrive in a virtual space, but back in person, and it’ll go from strength to strength. So thanks so much for joining us today.

  Nigel Ohrenstein:  Thank you for joining us today. Please follow us on your favorite streamer and don’t forget to rate us as it helps others find our podcast. I hope the spring is bringing new hope for all of us for a brighter future. Please join us next time as we tune healthcare, this is Nigel Ohrenstein in New York.