Monologue: Tripp Johnson on 21st Century Healthcare

In today's episode, Tripp illustrates the challenges we face as we disrupt and transform the current healthcare system. In the United States, between 1960 and 2019, our healthcare spend has gone from 5% of our GDP to 19% of our GDP. However, in the past few years, we've seen a decrease in lifespan, which is likely accompanied by a decrease in the overall health of many populations. Tripp attributes this problem to a stagnant model of healthcare that fragments patient access to services, ignores the social determinants of health, and relies on outdated systems of data collection and provider education.

Listen as Tripp proposes ways to reduce healthcare spending and promote human flourishing by integrating care, promoting value-based reimbursement, standardizing interoperable data, and ensuring that members of the healthcare field becoming flexible thinkers with an interdisciplinary set of skills.

Visit advaitaventures.com to join our mailing list and receive the slides from Tripp's presentation to SAS and drop him a line at info@advaitaventures.com to ask questions and give feedback.

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Flourish by Advaita Health explores how people, providers, and communities move from suffering to flourishing. Each episode weaves together perspectives from healthcare, wellness, and human experience — from the science of mental and physical health to the art of living well.

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Transcript

Welcome to the business of human flourishing podcast. Today we're going to try something different. I'm going to do a little monologue and I'm going to talk about what I think 21st century healthcare should look like. This is going to be a wide ranging talk. And hopefully it's coherent, I'm much more comfortable interviewing someone else, or having someone to converse with. However, I think some of these ideas are really important to package. And there are a lot of other leaders talking about this. And this is just my kind of take on it. So this is kind of based on a presentation I gave to SAS data and analytics company in Cary, North Carolina. And if you're interested in seeing the slides for this presentation, you know, you can sign up for our email list, and we will send this out. 

So 21st century healthcare. And I'm going to skip kind of rehashing a ton of things about how we got to this point. But what's important to know is that our healthcare spending has gotten, you know, out of control. And it wouldn't necessarily be out of control in my mind if we were getting much better outcomes. But from 1960 until 2019, our healthcare spend has gone from 5% of our GDP to 19% of our GDP.

And in the past few years, we haven't seen we've actually seen a decrease in lifespan. And I would argue health span as well. But we can get into that, you know, our healthcare system isn't just about prolonging the length of life, it needs to be about, you know, promoting our healthy lifespan. So if we're, you know, we're in a nursing home or in hospice care, and we're suffering from physical or cognitive decline, that doesn't mean we're really healthy. And so our healthcare system needs to be focused on increasing not just the lifespan, but also the health span of everyone in the United States. So what's going on kind of right now, in health care, like I said, We're at 19% of GDP is dedicated to health care, that's tremendous. What's driving this cost one, it's patient complexity, you know, we have a lot of sophisticated tools now, diagnostically. So we can see what's going on with people. And a lot of patients are presenting with comorbidities, meaning they're not struggling with just one thing. You know, maybe they're struggling with obesity and substance use, maybe they're struggling with diabetes, and hypertension, you know, a lot of things are occurring at once for people. And what's frustrating about this is, even though we have these comorbidities, that are you know, grouped together, it's very difficult to find a provider or even a provider group that can treat everything.  

So you end up our healthcare system is incredibly fragmented, you've got to go to one place for your cardiologist, you got to go to one place for primary care, you've got to go to another for mental health, you've got to go to yet another for substance use. So all of that makes it very difficult for the individual patient to navigate. And that's one of the reasons that people just aren't happy with healthcare. And what we would call is a net promoter score, most health care providers aren't even really tracking their net promoter score. And, yeah, that's a shame, we really should be building a healthcare system that focuses on the focuses on the experience of patients. And that's a theme that we're going to come back to a lot in this talk. So this fragmented healthcare system leads to people being pretty unsatisfied and just a disjointed patient experience. The problem is when you silo different specialties, into their, their own little realm, they can't get the information they need to treat you holistically. You know, it doesn't really make sense, your primary care doc doesn't know what's going on with your your mental health or substance use.

In fact, treating these in a siloed fashion can really lead to poor outcomes, let's say that you you know are in recovery from substance use, and you go to your primary care doc, and you're, you know, complaining about some anxiety, their impulse may be to prescribe something like Xanax, which really might kind of derail your recovery process. So that's, again, just a couple of

points about what's going on in the healthcare system. I think one of the encouraging things we have right now is that there's a new focus on the social determinants of health. And if you tuned into our open source health video, you'll kind of have a primer on the social determinants of health. But if you didn't, I'll kind of sum it up quickly. It's the non medical factors that really help drive health care outcomes. So this is stuff like your education level, your access to transportation, your access to the healthcare system, your economic or financial security, your ability to find stable housing, all of those things play a really big role in determining health outcomes. I think it's really encouraging that providers are starting to look at this.

So as far as the healthcare system goes, we need to be concerned with three things. And I'm going to harp on this over and over and over, we need to increase the access to health care, we also need to make it more affordable. And it needs to be higher quality. That means we need to have objective outcomes that are showing that our healthcare system works.

Now, some major themes in this healthcare three point, like I said, access quality affordability. As far as access goes, I mean, there is a limit to our ability to access healthcare just based on the number of providers, right. And so one of the things we've got to be focused on is how we can use kind of physician extending or provider extending technology. This is something that is there's a huge health tech industry. And I think a lot of it is very promising. But I also think a lot of it is kind of disconnected from the actual patient experience, when you have technology companies trying to build healthcare solutions, they may or may not be qualified to do so even if they have a couple of medical professionals, mental health professionals, whatever on their team, it doesn't really mean that they understand what kind of our health care delivery system looks like.

But we can get into a little bit more of that later. I do think there's some interesting stuff. I know, North Eastern has a personal health informatics program. My wife was actually getting her PhD up there before coming down to North Carolina. And I think there's some really interesting stuff going on there. There's a lot of interesting stuff going on in kind of the wearables, space, and all of that can provide kind of more access to care. So one of the things I like to talk a lot about is this idea of curriculum.

If you engage in a course, I have taken a lot of online courses, I wasn't a great student in school, but found my love of learning a little bit later in life. And I've found tremendous benefit from going through online courses. You know, I learned stuff like Adobe, what is it illustrator, and InDesign, and that just took a few hours online. Similarly, we should have a healthcare curriculum, stuff that really promotes our flourishing. And that should be provided by and monitored by our healthcare providers, it's ridiculous to think that we're going to go in and see our primary care doc once a year for a physical, and that's all we need. In fact, we should be able to get a tailored set of curriculum based on our kind of age, and stage in life. And maybe some of the issues we are either struggling with or hoping to optimize, let's today we're trying to add in, you know, exercise and maybe have a more balanced nutritional diet, it would be great if you could just kind of assign someone a module to learn about this. And that's, it's easy. And there's a lot of stuff out there, I don't want to say it's, it's not available, because anyone can go on YouTube and find plenty of workouts, they can find, you know, plenty of people spouting how to eat, how to do whatever. But this really isn't necessarily controlled by professionals. And so I think it's really important that we look at how we can improve access to health care by building tailored population specific curriculum. And it needs to be easy to use, one of the things that you'll see when new technology comes out is until there's like a simple, easy to use graphic user interface, it's going to be siloed for kind of the specialists. And we're seeing tremendous strides in this. I think when you look at companies like Noom, they're doing some interesting stuff. And other people are are certainly using technology to kind of extend the reach of providers.

Next, we want to talk about quality. And I think whole person care is certainly kind of the term or buzzword dujur and that just really means treating someone as a as a whole person, right? Like we can't separate mental health from physical health. These are so intertwined. And this is obvious, but yet, the way our system is set up, we are still forced to kind of go from you know, specialist to specialist. If we really want someone who knows mental health, then they're probably not going to be as well versed in physical health. And the problem is, they often aren't even able to communicate if we are if we have a primary care doc and a psychiatrist, unless they're in the same practice and even if they are in the same practice, sometimes their record systems aren't communicating with one another. And it's ridiculous. Like you can't Have your psychiatrists prescribing, you know, certain meds. And that's not really in your primary care physicians, wheelhouse and understanding, right? Like this is all connected. And they're both treating you from kind of their own limited understanding of what it's like to be you.

So whole person care, hands down, one of the most important things we can be doing. But this is just obvious. And unfortunately, it's hard to do. I mean, as someone who has a provider organization, or now two provider organizations, it's really tough, it's tough to get started. And it's expensive. Because if you're going to have an integrated care practice, you've got to bring on, you know, providers with different specialties. And it's very costly. But it's, it's so important. I believe there's a study by Blue Cross showing that there can be a 19% reduction in healthcare spend just by integrating care. So just so that you can have kind of primary care and behavioral health under one umbrella where the systems talk to each other, and there's communication between providers can reduce the cost of health care by almost 20%. And that's remarkable.

Finally, I think one of the things one of the big themes for 21st century healthcare, as far as quality goes is we're going to need to focus on the experience over the output. And what do I mean by that?

So I think of the output has right now in our current system, this is your CPT codes. This is what the providers are billing for. And this is what you know, patients are being prescribed or told to do. And there's it kind of misses I mean, healthcare right now has been pretty dehumanised. No, it's terrible going into your primary care, Doc, and having them, you know, type away the entire time, hardly make eye contact once they don't have time for you, because they just need to hit all their checkpoints. And it feels, you know, very depersonalized.

And as we continue to leverage technology, I think one of the biggest roles for the human element, and that is like for providers, is going to be to cultivate an experience that really engages patients, you know, you want to go somewhere where you feel like you've got a team kind of looking after you. And then you're really collaborating with your providers. And all of this needs to be tailored to your needs, it's ridiculous to think that there's a one size fits all solution for health, we're far smarter than that.

And finally, we haven't really talked about affordability. But I think that this is where there's so much room for innovation, especially on the business front. So value based reimbursement, this is something I am really, really passionate about. And if I'm being honest, I don't have that much experience with.

So the current model is called fee for service, meaning that when you show up to your provider, they are you know, charging, you know, either you or your insurance company a fee based on the service they are providing. And that service that they're providing is really based on if you're, you know, on the mental health side might be based on DSM criteria. Or just generally, you know, what we're billing to insurance companies are based on CPT codes. So you come in for some sort of evaluation and management session might be a 15 minute visit might be a 30 minute visit might be an hour visit. And that's a CPT code that they then go back and bill for. And there are kind of perverse incentives in this. So as much as we would like to think that we're not going to try and overbill or game the system, it's really hard not to especially because there, there tends to be this tension, but between, you know, providers wanting to get paid for what they do and wanting to make more money. And then the payers, the insurance companies, you know, it's tough for them, because as much as they want to, you know, look out for, you know, the people that have their health insurance, they also don't want to, you know, be preyed on by providers that are over billing. So how do we get out of that dilemma? We've got to create a an alignment between the incentives, because the providers incentives and the payers incentives right now are diametrically opposed. That's not good for anyone. Well, maybe it is. I don't think so. It's definitely not good for our healthcare system. So how do we get out of that? And it goes back to this concept of risk sharing value based reimbursement is really just a risk sharing kind of contract. It means for example, instead of if I'm if I'm a primary care doc, which thank God I'm not.

If you come in, maybe I work in a big healthcare system, that health care system is able to do whatever it needs to care for me, it can use any sort of intervention at once. But there's a cap, there's only so much that you can spend on each person. And that's scary. If you've got a lot of complexity, you might think, Well, I'm not going to get all the care I need, they're going to just say, I'm too expensive. That's not exactly how it works. Because the goal being that you have this huge patient base. So this doesn't work for small providers. And that's one place that we're gonna see a lot of innovation over the next 10 years, is that small providers are going to have to link together, I think there's, there's a huge opportunity, kind of with blockchain technology and smart contracts for small providers to work with, you know, within a larger system, even if it's kind of a distributed or decentralized system, but back to just what is value based reimbursement, okay. So, value based reimbursement means, as a provider organization, let's say I'm, you know, atrium health, then I have a patient base of, say, 100,000 people, and the insurance company, instead of saying, Hey, we're gonna pay you in this fee for service model, you tell us what you did. And then we will reimburse you, if we think this patient qualified for it.

Instead of doing that, what they're gonna do is, is there's going to be a lump sum. So basically, they're the insurance payers coming to atrium, and they're saying, Hey, we know on average, it costs $12,000, to treat a patient annually. Now that $12,000 is covering the entire risk pool. So you definitely have some people who are consuming $100,000 plus in healthcare, but you also have people who are, you know, consuming, basically zero. And the goal of this is to move us that why this is, to me, one of the most important kind of systemic unlocks for us is it puts us all on the same side, it puts us in a position where we are trying to achieve longitudinal wellness and health increasing that health span for someone, as opposed to just trying to fix something when it's broken, and see how much we can bill for it right. And so that in and of itself, if we can get kind of the payers, and the providers on the same side, trying to drive health care in the right direction, a lot of good stuff can come. Now, again, there tends to be this kind of perception that payers and providers are not on the same team. And that sentiment seems to be really pervasive. I mean, I've seen it throughout, you know, the past few years, that's just kind of the default. If you're a provider organization, you kind of blame the insurers. And then I assume insurers kind of blame providers for trying to overbill, etc. What I've seen from working directly with health insurance companies is that's just not true. They want to do they want to take innovative approaches, they want to help the healthcare system. But our incentives aren't aligned. And so it takes us working together in a transparent manner. Because what we really need is some of the data that health insurance companies have we need that actual actuarial data? That's a mouthful, I should have said we need the actuarial data. Because that's ultimately important. If someone's coming through, like for us at GreenHill. If they're coming here, they want to engage in abstinence based, you know, recovery, but they end up smoking, and that takes 20 years off their lifespan, then did we do our job? I don't know. It's tough to say. And so only when you have that real actuarial data, can you know how effective you truly are. And so the data that health insurance companies have is extremely important to providers.

Lastly, on the affordability piece, social determinants of health, I think this is another way that we are going to lower the healthcare spend, we spend so much money when patients end up admitting through an emergency room. And a lot of times this just happens because they don't have access to a primary care provider. They don't know how to use the healthcare system. And ultimately, we pay for it. So I think there's going to be a renewed focus on how we can address social determinants of health. And those are all those non-medical factors that really contribute to our healthcare outcomes.

So 10 years from now, I hope that we will look at providing affordable housing as a healthcare intervention. It's obvious. Now, you may say the healthcare system doesn't provide housing. Okay, great.

But ultimately, you know, it's the government that is paying for a lot of our health care. And maybe if we can look at this holistically, we can see that it's actually cheaper to provide housing for someone who is, you know, insecure in that area than it would be to try and address their healthcare needs. Because without stable housing, you know, maybe every time they need something, they just show up to the ER, they have no intention of paying for any services, but they need something and that's where they show up. That's a pretty, you know, that's a bastardization of the social determinants of health. But I think hopefully you get where we're going with that. So healthcare 3.0, access quality, affordability is integrated care, social determinants of health, value based reimbursement, and physician or provider extending technology is going to be huge.

So my beliefs about the future. And I think it's important because I listened to another podcast where I heard heard the guy that phenomenal investor, thinker, futurist techno progressive. And he said he invests in companies that are trying to build the future that he believes in. And I think that's what we should all be doing. So what do I think about the future of healthcare, first of all, insurance driven models are going to dominate. Ultimately, it's the only thing that scales and I believe that it's the only thing that can really increase our public health and reduce the overall spend. If we're not looking to build within the system, then we're leaving a lot of people out just because some of us have the luxury to go to whatever provider we want. That's, that's not helping our system as a whole. Just because we can spend money for concierge care, we can pay for private treatment, we can do this and that. That's just not the reality for most people in the United States. And unfortunately, there's a lot of innovative stuff going on in these kind of boutique worlds, even even with health care technology, focusing on optimizing health and performance. But that's not really translating down into population health. And so it's really important that we work within insurance driven models, that includes commercial insurance, Medicare, and Medicaid, this is really, really important. And those people, those companies are major components of us carving out a better future.

Next, silo to healthcare, this is going to go away, it's got to now it doesn't necessarily mean that every practice has to become a behemoth, where you have a cardiologist, an endocrinologist, a therapist, a psychiatrist, all under one shop. But we do need to break down the barriers for the information. If everyone's operating on their own kind of Electronic Health Record system, your colleague, cardiologist has one set of records, your primary care doc has another set, maybe they request sharing, but then what are they going to do read it and, and maybe stored in your file, that data that all of your your background isn't really getting captured?

This siloed healthcare really causes us to spend a lot more. And it really hinders our ability to do whole person care. So there are a lot of ways to innovate around that. But ultimately, I think what we're gonna see is a huge move away from this kind of siloed healthcare into system based care.

Finally, business models, I think, if we're on kind of the business side of healthcare, we've got to be looking at how we can either become vertically integrated from the kind of provider side,

all the way to the payer side. So what do I mean by vertical integration, I'm not really talking about just levels of care. So I'm not talking about if you're in kind of the mental health or substance use field, the idea of going from a detox to residential stabilization, to partial hospitalization to an intensive outpatient to an outpatient program. That's part of it. I mean, that is vertical

integration. And, you know, we see a lot of benefit from that when someone can stay in one system and receive, you know, their full health care needs. But that's only one piece. And I actually think it's a really, really small piece. Ultimately, when I think about vertical integration, I think about everything from the research that's being done. So let's take research in universities, that's maybe the top tier that has the, you know, trickle down, and that needs to get into implementation science. Implementation Science is really the the science behind implementing research at a clinical level, and that's really important. And if you're not in school, how are you staying current on the best practices, you know, continuing ed events etc.

But we've really got to focus on getting that kind of research cutting edge research down into clinical practice, then you've got the clinical practice. And we've got to tie that in with actual outcomes data that providers are generating. And then we've also got to tie that in with actuarial data that insurance companies are collecting. Because without that, we can't get a comprehensive picture of what the healthcare system looks like and where we're, maybe maybe we could unlock some key efficiencies.

And finally, with that, what I didn't touch on is there's there's also a lot when I think of this vertical integration, I think about like all of the other providers that we end up using other other kinds of healthcare, adjacent industries, stuff like contracting and credentialing for provider organizations is huge. This is a big business. And it's incredibly inefficient, it's the most frustrating thing we deal with in my mind, because there's so much paperwork involved, and it just increases the administrative burden. So that's one example. Another would be, you know, labs for toxicology, or any sort of bloodwork, etc. Those are vital parts of our healthcare system, and they help us really do diagnostics and, and get more objective measures about going on with someone's health. But if we don't control the rails of that, you know, basically, if I'm a healthcare provider, and I'm outside, I've got to outsource, you know, 10 different things. Each one of those companies that I'm outsourcing it to, might be making a 30% profit margin on that service. And, you know, that might be great for their companies. But that's just increasing the spend in the healthcare system. So we've got to look for a way to bring all of this under one roof. And if that sounds ridiculous, I'm sorry, but I think it's unnecessary. I think we need fully integrated healthcare delivery systems, so that we can actually see, you know, where the excess spend is, and everything else. And finally, beliefs about the future technology will play an ever increasing role in the delivery of healthcare services. And I am so tired of hearing about digital health transformation, when all you're talking about is, you know, a provider sitting on zoom, and you sitting in your your home, and you get to see your therapist or primary care, Doc, that's great. But we could have done that 10 years ago, we need, we need to lean really heavily into a lot of the technology piece.

So what does that healthcare system need, we need standardized, interoperable data, we need to focus on, you know, the collection of that data, the analysis and then providing feedback from it. So again, this means everything from research conducted at universities or other other research institutes, all the way down to actuarial science. And we've got to be able to talk about data and outcomes and use the same language. This is very difficult. But there's a lot of you know, there, there are a lot of kind of positive things going on. There's a company called fire, I believe it's f h IR, that is really trying to do this. It's an API that kind of links different EHR is together. super interesting. So standardize interoperable data, macro economic incentives. And that's what I was talking about with value based reimbursement. We need to get everyone on the same side of the table.

And then finally, I think leaders in healthcare are going to need to be able to translate technology into practice and into the patient experience. What does that mean? Like I said, I think so much of healthcare in the 21st century is going to be experience based. And we need providers that can actually use technology, to help them cultivate the experience, not just not just to do something slightly more efficiently. We don't need another EHR that does what every other EHR does. But we're going to see pretty soon that, you know, computers, machine learning AI, etc, will probably be better at making out, they already are better, let me be clear, we have algorithms that are better at diagnosing for a lot of things, then individual providers, that's important, but that doesn't mean we're comfortable with getting a diagnosis from a computer. Right? And so, even though that, that AI that machine learning might be more effective at actually diagnosing what's going on with us, we still really have a role for providers in translating that diagnosis and helping us you know, understand it and come up with with a good treatment plan.

So our healthcare system needs standardized, interoperable data macro economic incentive alignment and we need leaders that can translate technology into practice that develops a better patient experience.

And so we talked about this vertical integration piece, like I said, I like to think about what vertical integration is, is from kind of the research and development to the training and implementation science down to providers and how they have to organize. And what I mean by that is, you know, to become a provider, you need your licensing your contract, and you need a lot of administrative support on billing. And then we can talk about actual health care delivery, that's that that's a big component. But in the scheme of things, it's only it's only part. And then finally, that needs to trickle down and come back to kind of the insurance payers, whether that's commercial insurance or you know, government insurance, that they have a ton of it. And then you've got that, again, the actuarial data, the longitudinal stuff that we only really get a few years down the road, all of that when we talk about vertical integration, we have to look at the entire system.

So how would I come to this understanding?

And maybe it's not a great understanding, I don't know, you can be the one to judge that. I started GreenHill, about four years ago, we started with kind of outpatient therapy. And that's what we did, we did the Intensive Outpatient level of care. And we had a number of therapists and mental health counselors kind of on our team. Quickly, we realized that for us to develop a better for us to provide more quality care, we needed to bring in other specialists, we needed to bring in some of the outpatient medical services. In particular, we're talking about psychiatry, and we're talking about primary care. So that's what we've done now. And then ultimately, we've also kind of gone on this path of learning on the administrative side that, you know, we spend a ton of money outsourcing, things like billing or revenue cycle management, to third party companies. And so we're going through the process of integrating all of these functions into our company. And that means the credentialing and contracting process, the billing process, eventually, probably, you know, the the lab work, etc. And once we have all of that will become what I would call a platform healthcare company will have all of the tools to then go look at a specific population, and then tailor an approach to them. That's exciting. And that's kind of what my path of learning has looked like over the past past few years.

Now, what am I scared about, I want to talk about what I'm scared about. And it's that I really think I have a good understanding from the business side of what healthcare needs. And I'm worried that I'm not going to be in an organization that's going to be big enough to actually influence the healthcare space.

I said in the beginning that I'm a pragmatic idealist, I want to fix the healthcare system, you know, and this, I don't want this to be some aspirational goal, like I'm meaning I really want us to do something, I want us to make a better system. And the only way to do that is at scale. And so I've got a good good little business, I don't need to worry about that. But that's not my real interest, I want to change health outcomes, I want to help other people flourish, I've got a hell of a life, I think other people should be able to enjoy it, too. So that's why we're raising money and trying to do things at a larger scale here.

Some of my other fears are just in general, there's a myopic focus from different companies and organizations. And I think that that stems from this lack of macro economic incentive alignment, every stakeholder is trying to squeeze the other one for a little bit more money, or at least that's the perception. And we need people to think really big. I really didn't even want to start this podcast, I didn't want to start talking about this stuff in public, because honestly, I think there are a lot more qualified people to do it. But I'm not hearing enough people really beat the drum of what healthcare in the 21st century should look like. So I figured I would start.

I'm also I guess, I have a lot of confidence, probably that only child thing. Right.

So I do think it's, it's discouraging, right? We need people to have a bigger tent. We got to have people who really want to bring in stakeholders and reconcile differences. I want to be in the position between patients, providers, policymakers.

There was one more patients, providers, policymakers and payers, insurance companies, because until we get everyone aligned behind the same goals, it's gonna feel like a zero sum game.

And we've got to break out of that. There's so much more we could be doing.

And finally, I think it's this word eudaimonia, your diamond Ian. And it's this idea that we need to increase flourishing. And that that's really, you know, whether it's health care whether it's education, that's what we're all after. We all want to feel like we've got a purpose for life. We don't want to be, you know, suffering from ailments, illness, etc. We want to flourish, and our healthcare system should help us do that. We shouldn't just be going in to see a provider when something goes wrong, we should be going in proactively. I think this the idea of preventative care is also bogus. It's it's really a relic of the past. Still, yes, we need preventative care. But that's step one. We need to actually engage in a collaborative relationship with our patients. We need them to feel like that they are We are, we are kind of their advocate, we are like a head coach of their health team, right?

You know, they should be coming into us. And we should be looking at how to optimize their life, not just get them back to neutral, I feel like that's so much of what the healthcare system is based on. And it's discouraging, because ultimately, if your job is just to get someone back to neutral, you're coming in, you're unhappy. And then unless you get at least neutral, you're still going to be unhappy. That puts us in a bad situation. If we can be a little more aspirational, that would be great. Let's, let's really collaborate with our patients. Let's help. Let's understand from them what their goals are. And then let's help them achieve.

Now, just to wrap up a couple things on health care leaders, what do we need in the 21st century. In the 21st century, health care leaders need to be interdisciplinary thinkers, they've got to have a ton of cognitive flexibility. This is super important. We cannot continue to practice our siloed healthcare and just optimizing for our own outcomes. That's not great. It's not helping patients. Finally, leaders in the 21st century are going to need to be focused on these meaningful experiences, this is going to become more and more important. Again, technology is outstripping our abilities in almost every realm. And that's okay. It's scary, we may become obsolete for what we're doing now. But in cultivating an experience, we're not going to become obsolete, net least for the next 100 years.

And then finally, we really got to focus on training and retraining people on our teams. The pace of change is incredible right now. And unless we are really focused on on that training and development of individuals on our teams, then they're always going to be behind, it's really unfortunate that our education system is set up in a way that you kind of go get your education. And then you go get to, you know, practice, whatever that is, whether it's business, healthcare, etc. I mean, we should be going back to school, especially with the pace of change that's going on now. You know, we need to be going back for like a real refresher. Every few years, maybe every five, maybe every 10 years, you take a semester, two semesters worth of coursework, I don't know. But something's got to change. Because there's nothing worse than us, you know, using yesterday's best practices that are now obsolete.

So I think that's really important for leaders, you know, they've got to be interdisciplinary, flexible thinkers, they've got to focus on this meaningful experiences. I think that's a huge unlock for healthcare outcomes as it is, if we could just try and make the experience of people better, they're going to engage more. And then finally, we got to be focused on training and retraining people on our teams. We've got to provide them access to resources for their own continuing education. That's really important.

All right, so how long was that? Let's see. 39 minutes, I just talked for 39 minutes by myself. I'm not surprised. But I hope this was somewhat useful.

I think this is a primer, I think this is probably going to be part of a larger kind of series about hashing out kind of my vision and hopefully bringing other people in who have a much better idea of what healthcare should look like.

But hey, this was useful to me as it is. So thank you for listening. And I would always appreciate feedback if you want to send an email info@advaitaventures.com that will be in the show notes. You can find us on Facebook, LinkedIn, and Apple podcast Spotify. So if you would

Give us a download share, we'd love a comment or a review, because it's lonely doing this. It's lonely. But it's a lot of fun too. So 21st century healthcare, let's make a better system, quit operating within just within the constraints of the system, but don't ignore them. If you're only focused on providing people care that is outside the system, then you're missing most of Americans. And most of us got into health care, because we really want to help people. We want to make the world a better place. And we can do that. But it's going to take a lot of work. It's going to take a lot of collaboration  . So thanks a lot. We'll catch you next time. I'm Tripp Johnson, signing out.