EP455: A Leadership Blueprint for Measurably Better Care, With Beau Raymond, MD

Relentless Health Value™

A rate critical to attain better care for patients, I’m gonna say, is enlightened leadership—maybe dyad leadership—at a clinical organization. I am saying this because without enlightened leaders, it’d be harder to build from the blueprint that Beau Raymond, MD, talks about today on the show.

For a full transcript of this episode, click here.

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I’d say an enlightened leader is someone—and this is my definition, but it’s a term that Tom Lee, MD, brought up first in an earlier episode (EP445)—an enlightened leader really cares about providing better patient care at an affordable price. They have a manifesto to that end, if you will.

They also have studied, likely, and understand how change management works because every improvement requires change. They get the bit about people, processes, and technology being intertwined and what operational excellence means.

Further, they are probably doing or considering many of the things that Robert Pearl, MD, talked about in episode 412. On the opposite end of the spectrum, there’s a new term floating around called administrative harm. There’s a study. Admin harm refers as much to what administrators—who I refuse to call leaders at this context because I’m talking about the not good administrators, so let’s be clear—but I’d say administrative harm results from what the administrators choose not to do as much as what they choose to do.

It is actually a thing to be an enlightened leader, especially in these profit-driven times. It’s really tough, actually, and nothing anyone should take for granted. So, maybe this whole show is kind of a shout-out to the enlightened leaders out there. Thanks for doing what you do.

Okay, so this said, and it needed to be said, let’s talk blueprint for better care in the conversation that follows.

Dr. Beau Raymond says, step 1, right out of the gate, set clear goals.

Then step 2, engage others throughout the organization to together build the framework needed to achieve said goals. Engaging frontline folks and others is really the only way that any proposed framework will actually work in the real world. Listen to the shows with Karen Root (EP381) and Ashleigh Gunter (EP447) for just one proof point after another that what I say is based in fact.

Step 3 of the blueprint to better outcomes that Beau Raymond, MD, talks about today is get your data. We talk a lot about plan sponsors and the getting of data, but same thing applies to clinical organizations. For clinical organizations, the getting of data means longitudinal data. The need for longitudinal data has come up in multiple shows, most recently the one with Dan Nardi (Spotlight Episode), and this is just one example of why getting the whole bag of data really matters.

Dan said on that earlier show, it’s often a thing that oncologists are unaware of how many of their patients are winding up in the ER for nausea after chemo, which, by the way, is the most common cause for readmission. And the reason for this is lots of patients travel to their oncologist but go to a local ER in a different health system.

The show with Brendan Keeler (EP454) about the Particle v Epic lawsuit in general dustup over who gets the data is super relevant here. That’s what I was thinking when I was talking with Dr. Raymond, and maybe it just popped in your head, too. Or just continuing this topic of the importance of longitudinal data, how many specialists, in almost any specialty, see a patient and then don’t know what happened to that patient subsequently? Or even primary care in transactional models?

So, step 3 here is get your data and also, as part of that, figure out how to make sure everybody understands the data and also understands that it is fair. Eric Gallagher (EP405), Dr. Raymond’s dyad counterpart over at Ochsner, talked about this some in that episode. So did Kenny Cole, MD (EP431), interestingly, also from Ochsner. Amy Scanlan, MD (EP402) mentions it as well.

Step 4 in the blueprint to measurably better outcomes that I discuss with Dr. Beau Raymond, data collection and data management probably need to be system-wide because … yeah, longitudinal and etc. But the “What are you gonna do now with the insights that you derived from the data?” is pretty local.

The obstacles and enablers are going to be different depending on the geography. For example, an area with a large Vietnamese population and a big variation in colorectal screening rates as a priority, just logically, is gonna have a program that is in no way suited to roll out in an area with, say, a large Black or African American population with high hypertension rates.

Priorities and programs are just different depending on the geography. So, step 4 here is, ask each region, based on the data, what fixes they’re going to own. What will they take ownership on and commit to improving?

What I thought was interesting in this interview is kind of the way that equity comes up between ethnic groups or between genders. In and of itself, obviously, striving for equity is critical. But also, if you’re trying to improve quality across the board and you see disparities in care, figuring out what is going on with the group experiencing the worse outcomes is also just operational excellence. You don’t want to be a solution looking around for a problem, after all; so, you need to figure out the actual problems for the actual people experiencing the problems to avoid that.

Those are the only solutions that are actually gonna work.

Step 5 is to learn from each other. Maybe not a whole program is flat-out transferable from one geography to another, but that doesn’t mean that nothing is transferable either. As usual, it’s about being thoughtful and nuanced and finding that productive middle.

At Ochsner, they do these cool weekly primary care huddles to share learnings and goings-on that Dr. Raymond explains in the show that follows.

Throughout all of these steps in this blueprint, there is obviously a need to align how the practice or system is getting paid for the time and capital expenditures, of course. And Dr. Raymond addresses this and interestingly says something similar to what Dr. Tom Lee (EP445) and Scott Conard, MD (EP391) have said on earlier shows: that a lot of times compensation for improving care, if you do it in an operationally excellent way, can be revenue positive for systems with a combination of both FFS (fee for service) and value-based reimbursement.

Underline, however, the part about having an enlightened leader who cares about clinical quality for that to work out.

Dr. Beau Raymond, my guest today is chief medical officer for Ochsner Health Network. Ochsner Health Network, by the way, includes Ochsner and some other health system partners. There’s also a bunch of small independent practices of one to two docs.

Ochsner patients, in case you are unaware, are in the entire state of Louisiana, a little bit of Mississippi, Alabama, and also Texas.

Also mentioned in this episode are Ochsner Health; Tom X. Lee, MD; Robert Pearl, MD; Karen Root, MBA, CCXP; Ashleigh Gunter; Dan Nardi; Brendan Keeler; Eric Gallagher; Kenny Cole, MD; Amy Scanlan, MD; Scott Conard, MD; Joshua Liu, MD; Eboni Price-Haywood, MD, MPH, MMM, FACP; and Chris Skisak, PhD.

You can learn more at Ochsner Health Network and by following Dr. Raymond on LinkedIn.

Sidney H. “Beau” Raymond, MD, MMM, FACP, is a board-certified internist now serving as the chief medical officer of Ochsner Health Network and medical director and executive director of Ochsner Accountable Care Network.

Prior to joining Ochsner, Dr. Raymond was vice president, physician practice administrator, and chief medical information officer at East Jefferson General Hospital (EJGH). His experience included serving on the steering committee and later as a board member for Gulf South Quality Network. Beyond the administrative roles at EJGH, Dr. Raymond was involved with medical staff committees, including serving as chief of staff. He is also a past president of the Jefferson Parish Medical Society.

Dr. Raymond earned a bachelor’s degree in biology from Loyola University, earned a medical degree from the Louisiana State University School of Medicine, and completed his residency in internal medicine at LSU-New Orleans. He has also earned a Master of Medical Management from Tulane University.

07:50 What is step 1 of improving care for healthcare leaders?

10:44 Why is it important to be flexible while keeping your goals in sight?

11:48 Dr. Eboni Price-Haywood’s article on disparities in COVID.

12:29 How is equity a data point to achieving overall care improvement?

15:01 “If you can’t measure it … accurately, you’re not going to be able to do anything differently.”

20:52 What strategies have been successful in using data to improve healthcare outcomes?

23:17 Why did Ochsner Health avoid looking at the individual physician standpoint in regard to an equity standpoint?

30:40 Why engaging patients in their healthcare actually improved patient visits and did not necessarily reduce patient visits.

34:49 “It’s really about engaging with the patient.”

You can learn more at Ochsner Health Network and by following Dr. Raymond on LinkedIn.

Sidney H. “Beau” Raymond, MD, MMM, FACP, discusses #leadership on our #healthcarepodcast. #healthcare #podcast #financialhealth #primarycare #patientoutcomes #healthcareinnovation

Recent past interviews:

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