Nirav Shah, MD, MPH, Senior VP and COO for Clinical Operations, Kaiser Permanente Southern California

Today's guest is Dr. Nirav Shah, the Senior Vice President and Chief Operating Officer for Clinical Operations for Southern California in the Kaiser Foundation Health Plan and Hospitals, in Pasadena, California. Nirav oversees the health plan and hospital quality, service, accreditation, regulatory compliance, and licensure, as well as nursing, the continuum of care, and the effective use of technology, data, and analytics to produce better patient health outcomes for $24B region serving 4.2M members.

Prior to coming to Kaiser, Nirav served as the Commissioner of Health for the State of New York, administering a $60B budget and was responsible for public health insurance programs covering 5 million New Yorkers as well as regulating the state's hospitals and nursing homes among other responsibilities.

Nirav completed an internal medicine residency at Yale, followed by a fellowship in epidemiology at Stanford. Before moving into leadership roles, he worked as a physician researcher at Bellevue Hospital in New York City and at the Geisinger Clinic in Pennsylvania.

I really enjoyed listening to Nirav's journey from physician researcher to large organization leader. Perhaps more than any other guest, Nirav talks about the importance mentors have played in his career, and how he seeks out support and guidance to help him solve his problems, while at the same time reaching out to return the favor.

Links to the Podcast:

Anchor: https://anchor.fm/healthleaderforge/episodes/Nirav-Shah--MD--MPH--Senior-VP-and-COO--Kaiser-Permanente-Southern-California-egra6j 

Stitcher: http://www.stitcher.com/podcast/the-health-leader-forge

iTunes: https://podcasts.apple.com/us/podcast/nirav-shah-md-mph-senior-vp-coo-kaiser-permanente-southern/id981989377?i=1000372542503

Transcript: A transcript of the podcast is available here.



Podcast Outline

Time Topic
0:02:22 Upbringing in India
0:03:41 College experiences, deciding to go into medicine
0:05:06 Completing a dual M.D./M.P.H. program in chronic disease
0:06:15 Being in a Pass/Fail environment at Yale Medical School
0:07:47 Residency in Internal Medicine
0:08:30 Fellowship in Epidemiology
0:10:20 The “Physician Identity”
0:11:31 Early career at NYU Medical Center/Geisinger Health System
0:14:34 Balancing the demands of a clinical vs. research career
0:15:24 Early career mentors, privilege, and grit
0:19:00 Early interests in administrative and leadership work
0:21:13 Work as the Commissioner of the NY Department of Health (DOH)
0:25:00 The importance of having a political appointee as a Commissioner
0:27:27 The importance of building networks for future leaders
0:29:12 Role of the Commissioner of the NY DOH
0:31:30 Reforms to Medicaid at the NY DOH
0:33:30 Dealing with conflicts as the Commissioner
0:35:25 Difficulties of implementing reform
0:37:48 Relationship with Kaiser Permanente prior to and as Commissioner
0:39:25 Leadership lessons learned as the Commissioner of the NY DOH
0:40:33 Shift to working at Kaiser Permanente
0:42:55 Advantages of the Payer/Provider alignment at Kaiser
0:48:38 Size and scope of Kaiser Permanente and KP Southern California (KPSC)
0:50:22 Day-to-day life and responsibilities
0:51:36 Use of data and analytics to improve patient outcomes
0:54:43 Benefits of KPSC and hospital association
0:56:03 Relationship between corporate and regional KP organizations
0:58:15 Regional leadership team organization
0:59:15 What keeps you up at night?
1:00:40 How did prior experiences prepare you for Kaiser?
1:02:48 Common misconceptions of Kaiser
1:04:11 Are you currently practicing medicine?
1:05:23 Questions regarding leadership, personal mentors, and leadership experiences, hiring and evaluating leaders
1:10:25 Working with “inexperienced” leaders, evaluating performance
1:13:20 Importance of organizational culture
1:15:30 Advice for students in developing good mentor relationships
1:19:54 Importance of professional associations in career development

1:20:54 Advice for clinicians/students going into healthcare 

Links Discussed

Kaiser Permanente Southern California
NY Department of Health

Geisinger Health System

Bellevue Hospital

Don Berwick

Robert Wood Johnson Foundation Clinical Scholars at UCLA

Yale Medical School

Thanks to Sameer Panesar for production support.

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Dr. Joseph Pepe, MD, President and Chief Executive Officer of CMC Healthcare System

Today's guest is Dr. Joseph Pepe, MD, President and Chief Executive Officer of Catholic Medical Center Healthcare System. Dr. Pepe has served the CMC Healthcare System since 1990, first as a staff physician, then as Chief Medical Officer, and since 2012 as the system President and CEO. The advice he gives early careerists entering the field of administration is to volunteer for additional responsibility, and that positions will follow. His own career reflects that fact. In the interview, Dr. Pepe describes his choice to become a primary care physician, and how his interest in improving the operations of the practice resulted in him being "volun-told" that he would be the Chief Medical Officer. After thirteen years of successful leadership as the Chief Medical Officer, Dr. Pepe was selected to lead CMC as the CEO and president. We discuss strategy and how Dr. Pepe is working with the board and senior management to ensure CMC's success in a rapidly changing health care environment, while remaining true to CMC's Catholic identity. We conclude with a discussion of leadership and mentorship.

I really enjoyed this interview because Dr. Pepe made it clear that CMC’s identity as a faith-based organization goes beyond just a historical origin; it is critical to the organization’s mission today, and influences its strategy on an ongoing basis. 

Links to the Podcast:

Soundcloud: https://soundcloud.com/healthleaderforge/dr-joseph-pepe-md-president-and-chief-executive-officer-of-cmc-healthcare-system

Stitcher: http://www.stitcher.com/podcast/the-health-leader-forge

iTunes: https://itunes.apple.com/us/podcast/healthleaderforge/id981989377

Transcript

Podcast Outline

Time	Topic
0:02:23	Educational background, wanting to become a physician
0:04:48	Medical school at Tufts
0:06:45	Residency in internal medicine
0:07:37	The “Physician Identity”
0:08:46	Working at Catholic Medical Center (CMC) after residency
0:09:50	The community of Manchester, New Hampshire
0:11:10	History and mission of CMC
0:15:04	Size of CMC
0:16:03	Being a hospital-employed physician at CMC
0:17:34	Transitioning from clinical practice into hospital administration
0:20:05	Role as Chief Medical Officer at CMC
0:21:37	Organization of CMC’s medical staff, peer review
0:24:13	Helpfulness of CMO experience in the CEO role, conflict resolution
0:26:34	Day in the life of a hospital CEO
0:27:34	Advantages of being a physician-administrator, moving to value-based reimbursement
0:29:26	Do you see patients as the CEO?
0:30:09	What metrics do you track?
0:31:26	For people outside of healthcare: what’s it like to run a hospital?
0:32:34	Function, responsibilities, and composition of the CMC Board of Trustees
0:35:54	Most difficult part of being the CEO
0:37:46	CMC’s partnerships with other hospitals, external entities
0:39:48	Biggest surprise upon becoming the CEO, growing into the position
0:42:39	Strategic planning processes at CMC
0:46:22	Adapting to value-based reimbursement at CMC
0:48:26	Growth opportunities in healthcare
0:50:12	Partnerships and reimbursement in “population health”
0:52:38	Personal leadership philosophy
0:54:17	What makes a good leader? Why?
0:56:52	Hiring and evaluating good leaders
0:59:41	Personal mentors
1:00:51	Developing leaders within an organization
1:03:21	Membership in professional organizations, professional career development
1:05:30	Importance of involvement in professional organizations, networking
1:07:22	Advice for young clinicians and others looking into a career in healthcare administration

Links to Topics Discussed:

Catholic Medical Center

St. Anselm College

Tufts School of Medicine

Granite Health

Tufts Health Freedom Plan

Thanks to Sameer Panesar for production support!

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Dr. Michael Sherman, MD, MBA, Chief Medical Officer, Harvard Pilgrim Health Care

Today's guest is Dr. Michael Sherman, the Chief Medical Officer and Senior Vice President for Health Services at Harvard Pilgrim Health Care. Harvard Pilgrim is a New England-based regional health plan with 1.25 million members. It has been ranked #1 by NCQA for the past ten years. Michael holds Bachelor’s and Master’s degrees from the University of Pennsylvania in Medical Anthropology, he attended Yale Medical School, and is a board certified anesthesiologist. In the mid-1990's he made the decision to pursue an MBA at Harvard Business School with the thought that he would seek to blend together his clinical expertise with a business education, but he was sure of one thing: that he would never work for an insurance plan. In this podcast he tells the story of his career, about becoming a physician, making the transition to executive leadership, and how he ultimately worked for three health insurers (ironically, the payers he said he would not work for). Michael's career involves a great deal of serendipity, but it also shows his deliberateness as he worked to develop the skills he knew he needed to progress as an executive by gaining exposure and experience in a wide array of organizations. He is also quite candid about his successes and challenges, which shows that the road to senior leadership is never smooth sailing.

His discussion of the work he is doing with value-based payment and bundling at Harvard Pilgrim is particularly useful and timely. It is very popular to demonize health insurers, but Michael’s efforts to create win-win arrangements between Harvard Pilgrim and its partners in the provider community shows what is actually possible. It is interesting to see how his passion for developing these agreements meshes with a recurring theme of negotiations from different points in his career leading up to his current role. The podcast concludes with a discussion about Michael's leadership style, and his recommendations for physicians who are looking to make the transition from clinical leadership to executive leadership.

The interview is available in its entirety at the unabridged link below. The podcast outline corresponds with the unabridged version. There is also an abridged version of the interview that focuses primarily on Michael's work immediately leading up to his current role. 

Links to the Podcast:

Anchor:

   Unabridged: https://anchor.fm/healthleaderforge/episodes/Dr--Michael-Sherman--Chief-Medical-Officer--Harvard-Pilgrim-Health-Care-egra8g

             Abridged: https://anchor.fm/healthleaderforge/episodes/Abridged-Dr--Michael-Sherman--Chief-Medical-Officer--Harvard-Pilgrim-Health-Care-egra7r

Stitcher: https://listen.stitcher.com/yvap/?af_dp=stitcher://episode/41445563&af_web_dp=https://www.stitcher.com/episode/41445563

iTunes: https://itunes.apple.com/us/podcast/healthleaderforge/id981989377

YouTube: https://youtu.be/nxkYEFZWuKU

Podcast Outline (these times apply to the full length version)

Time	Topic
0:02:56	background education, becoming a physician
0:13:11	decision to go to business school
0:23:06	the importance of establishing self as a physician before going into business/leadership role
0:25:21	DaVita, Inc.: Director of Corporate Development, DaVita, Inc.
0:30:57	HealthAllies: Vice President, Provider Business Development and Product Management
0:36:37	IMMUSOL: Vice President, Medical Affairs
0:43:08	Thomson Reuters: Vice President & General Manager, Health Plan Solutions
0:54:27	Transition to the payer world: United Health Group
1:00:38	Humana: Corporate Medical Director, Physician Strategies
1:12:43	about Harvard Pilgrim Health Care
1:17:09	Harvard Pilgrim Institute/Harvard Medical School Department of Population Health
1:18:55	Chief Medical Officer and Senior Vice President, Health Services
1:21:52	Paying for value, one size doesn't fit all
1:34:45	Consolidation of Health Insurers
1:36:27	Thoughts on leadership, hiring the right talent, and being an executive
1:51:02	Mentorship
1:52:51	Professional Organizaitons
1:54:26	Advice to clinicians who want to make the transition to clinician executives

Topics Discussed:

Harvard Pilgrim Health Care

Harvard Business School

DaVita

HealthAllies (Optum HealthAllies)

Thomson Reuters

UnitedHealth Group

Humana

America’s Health Insurance Plans (AHIP)



Articles by Dr. Sherman:

              Paying for Value: What's Next?

              How to Design a Bundled Payment Around Value

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