Keeping the Humanity in Healthcare - John Driscoll, CEO, CareCentrix, Inc.

RISHI DESAI: I'm Dr. Rishi Desai, and today on Raise The Line, I'm happy to be joined by John Driscoll, CEO of CareCentrix, a company that connects patients with the care they need at home through a national network of over 8,000 credentialed provider locations.John has been a leader in healthcare for over 25 years, helping to build major healthcare businesses, including Medco, Surescripts, Oxford Health Plans, and CareCentrix. As an example, he helped facilitate Medco's entry into Medicare, growing the business from a startup to 20 billion dollars in annual revenue.John, thanks so much for being with us today.

JOHN DRISCOLL: Delighted to be here.

RISHI DESAI: So maybe just to start out, how are you doing? How's your family in the context of COVID-19?

JOHN DRISCOLL: We are super lucky. From my 88-year-old mom who is safe and sheltering and socially distant in Cape Cod, to my kids who are spread around the country, who have probably been less socially distant, but have stayed healthy. My wife and I are all good. The kids are all right, everybody's healthy, and we've not been really touched by COVID. It's just been such a weird time.

As a company, we've been very successful at CareCentrix, providing care to the home with 2,000 employees, all from home. But just because of that exposure with our knowing the lives that our employees have, there just have been so many lives that have really been harmed or lost, based on this horrible disease. We just count ourselves as one of the lucky ones.

RISHI DESAI: Thank you for sharing that. I concur, our family's been very lucky as well, and we can't help but think about the fact that so many lives have been touched by it. Living through that has been a very interesting time, to say the least.I'm curious about your background in healthcare. Rewinding the clock a little bit, what got you interested in the healthcare field way back when you started?

JOHN DRISCOLL: My mom was a nurse, and had a very idealistic view of what a nurse does. She's my mom, so of course, I think she's perfect. She's the center of a lot of love and happiness. And so, there's sort of a sense of caregiving and care really matters.

Unfortunately, my sister had cystic fibrosis. I was very young, and even when you're an eight or nine-year-old, when this beautiful baby is going in and out of the hospital on a regular basis, you realize that a day at home is really a blessing, and a day at the hospital is a terrible, terrible loss.

It felt more acute. She had cystic fibrosis in the 60s, and so she passed at about her first birthday. But I had a very clear sense of both the power and the beauty of caregiving and care, and a sense of how healthcare, bad or good, can intervene in your life in a pretty dramatic way.

Then, fast forward to when I was in business. I'm sort of an idealist. I had actually spent time building housing programs for homeless families and mentally ill people before I got to business school, so I'm mission-driven. And what I realized when I was a young consultant is, in healthcare, there was an opportunity to really do a lot of good by just bringing disruptive new approaches to what I saw as a really flawed system that treated patients as transactions, and was really set up from a business perspective to make sure the bills got paid, but not necessarily the care got delivered, or that the care was optimal. So right after business school, I decided that I was going to try to build better businesses in healthcare to achieve the idealistic hopes that I had for getting care right, provide more solutions for patients and families, and hopefully lighten the burdens that folks like we had, with a chronically ill baby.

RISHI DESAI:What was your first business that was aligned to that sense of mission?

JOHN DRISCOLL: I cold called my way into Oxford Health Plans, which at that point, had about 100 employees. Well, less than 100 employees, and about 100 million in sales. I convinced them that I want to start a—and this is in 1991—a Medicare and a Medicaid managed care business, because I was particularly upset at how poorly coordinated care was for Medicaid,  initially, and then Medicare eligibles, folks who were poor and vulnerable.

At the time, New York City was doing a one-time, mandatory demonstration project in southwest Brooklyn for Medicaid, and so it was a really neat opportunity to really test. You had perfect visibility to the data. You were in a working or lower class part of Brooklyn with a heavy Medicaid population, so it was a live opportunity for us to build a business and a new care model in a part of the country that was really a healthcare desert. It was just a very challenged environment, and the most effective part of that part of Brooklyn was the trauma unit in the emergency room at the Coney Island Hospital. We built that. You'd rather be lucky than smart. 

At Oxford, we were very successful. The company grew from a hundred million to four and a half billion over six years. Our division, Medicare and Medicaid, went from zero to a billion three over the same period, and we were top 10 in the country in both of those areas, just in the New York metro area and Philadelphia.

It was all based on what was innovative at the time, which was whole patient care, looking at some of the social, economic, and emotional challenges that Medicaid, the program for the poor, and Medicare, the program for the elderly, eligibles were dealing with. It turned out that if you were whole-patient focused, really trying to connect with what the patient's need was, that you could actually deliver better care at a lower cost and delight patients.

I just happened to join Oxford at a time when the market was moving. What we were offering for the Medicare/Medicaid eligibles was what folks wanted, which was a health plan that saw them as who they are, whether it identified the cultural differences in the Latino, versus the Russian, versus the Chinese community, which is critically important in Medicaid. Or whether it understood the particular challenges of different Medicare eligibles, surviving spouses, caring for someone with dementia, an aging female with a risk of hip fracture, and then just the challenges of loneliness and food insecurity for the elderly. By focusing on patients first, we built health plans that were wildly popular at the time.

RISHI DESAI: You're touching on so many different social challenges. And I'm curious, what trends have you seen then over the years that weren't really so obvious back then, but now in 2021?

JOHN DRISCOLL: Well, let's start with the phrase that only a healthcare economist could love, the social determinants of health. I mean, that really is just dealing with one of the challenges that a patient has. Here's a great insight: if you're starving, you're probably going to have a hard time thinking about going to the doctor and managing your day-to-day life.

It seems everything that's old is new. Everything new is old, everything old is new. Let me, rather than just sound like a cranky old man, in the 60s, when there was a tremendous amount of social resources available, not always aimed at the right things, there were some great doctors who pointed out—one doctor was writing prescriptions for hamburgers. Because he said, in the Mississippi Delta, getting meat into their diet was far more important than building a community health center, although that was important, too.

What's exciting to me now is that, we are starting, based on the pure economics—which is why it's such an ugly phrase—to deal with the real challenges of being poor, elderly, or chronically ill in America, and I think that's exciting. The other thing that's exciting is that, the information that was locked and not portable and blocked, that prevented us from doing things like e-prescribing is now treated as a bridge to the future that we are committed to as a country and a community.

Those are the two biggest changes that I think lay the foundational groundwork. Whole patient and access to data, that will hopefully allow us to continue to transform and reform the American healthcare system in a way that's sensible, and that's heart and person centered.

RISHI DESAI: I recently was—I wasn't a participant in this, but I was watching a debate unfold about that phrase, social determinants of health. The argument was that that phrase is so wonky, that people can't really understand it and don't relate to it. The person was saying, "Why don't we just say what it is? Why don't we just call it being poor?" So many of the factors in social determinants of health come back to poverty. 

Then there was a whole other side that said, "No, no, that doesn't capture it. There are other elements here that we can't miss out." So that phrase, then, wonky as it may sound, doesn't really do justice to the breadth of issues. 

I'm just curious if you have any sort of take on this debate, because I think that we talk about it so much, and so the words matter. I'm curious to get your thoughts on that.

JOHN DRISCOLL: For me, because I agree with both of the people disagreeing with one another, I think that what bothers me most about the phrase is it does what I think we do, too, frequently in healthcare, as healthcare experts or providers, is turn the personal into the technical. We dehumanize, and I don't think we honor the common vulnerability and humanity by using words like that.

I go back to whole person care. Because I think that if you go with whole patient care—At one point, at Oxford in the 90s, we said, "We don't provide healthcare. We provide human care." And people were like, "What are you saying?" But that's really what this should be about.

Healthcare should be human care, and I think poverty—We no longer tell the lie that we can solve poor people with healthcare challenges with purely healthcare solutions. So that, I totally agree with.

But if you don't include behavioral, which is a problem regardless of income or coverage, I think we have not honored whole patients by not dealing with mental, social, and behavioral issues in an honest, direct way. I think the other piece we sometimes miss is how connected the healthcare problems are with bigger social problems, like the fact that we have a declining lifespan among non-college-educated whites who are really suffering from a cluster of deaths of despair that are related to opioid abuse, death by suicide, a whole series of other things, alcoholism.

I think the only way you don't go down that spaghetti string of argument is to go back to whole patient. Can we solve a healthcare problem if we see our neighbors in full? What can we do to help contribute to their health and welfare? Small w, welfare. I think if you start there, then you'll naturally deal with issues of income inequality, of racism, of emotion, and of disconnection, all of which I think are quite relevant, and honestly, remarkably easy to solve or improve if we deal with them directly.

RISHI DESAI: Yes, I think that's a very eloquent way of summarizing why these words and phrases remove the person from the equation. You forget that there's a human being behind all this stuff. So, I think that makes sense. That leads me to my next question, which is around the home, where the person lives. Do you mind just sharing an overview of how CareCentrix thinks about, and changes, how people are thinking about home healthcare?

JOHN DRISCOLL: I think again, because we don't want to get locked into a payment category, we're very clear about saying we want to reform and reimagine care to the home. Our mission is to help people heal and age at home. We sell to health plans and take risks from health plans to keep people out of the hospital in terms of avoiding unnecessary admissions and reducing the number of days in nursing homes. We do that by addressing whole-person issues, by identifying, through analytics and machine learning, what's likely to go right and wrong, based on our history, and by making sure that people understand their diagnosis. We spend a lot of time focusing on caregivers and supportive folks—-it could be the family, it could be in the community—who are the invisible superpowers, the caregivers, but are often burdened and uninformed.

Finally, we do a really good job organizing and managing the services that are covered to the home—nursing home infusion provided by nurses or not, home health—and then we tie and enable the patient to get the care they need by making sure they understand it with our help, and we tie that from a behavioral perspective to what that patient's goals are. So we can provide more support at home. We can predict what's likely to go wrong. We can make sure you get transportation and food. 

When you're thinking about a patient who's trying to heal, often healthcare focuses on the specific healthcare check, you know, your hemoglobin A1C for a diabetic, or are you doing the physical therapy for your recuperating from a back surgery.

We start with a behavioral point which is an insight, what does the patient care about? Does the patient care about seeing their friends to play cards or their daughter at preschool? Because we want to solve the gaps in care that are associated with care not provided, or care that's not necessarily healthcare involved. That's the whole person stuff. We want to tie it back to, how do you motivate folks to do the things they need to do with healthcare in healthcare, which are kind of dull and complicated? We can support that to what they care about most.

Often, the other point of emotional disconnection of healthcare and patients is, we don't tie, for example, the rehab to specific things that patients who are recovering want. If you can do that, I think that also lifts up and aligns the patient with the care plan in a way that again, honors the individual patient's or family's desires. That's absolutely critical. You tie the healthcare goals to people's hearts and dreams, you solve through analytics for what might go wrong, and we can dramatically cut costs, improve outcomes, and by the way, make doctors' jobs easier because we're also feeding information back to the doctor that they've never seen before.

We believe that we can transform the healthcare system and really, dramatically reduce the days in hospitals and nursing homes, and dramatically increase healthy days at homes, and we'll take risks from health plans to prove it.

RISHI DESAI: It's funny, I had a pediatric patient who had a central line for a cancer chemotherapy. I was wondering what his biggest concern was. He was a young boy. The parents said, “He doesn't really even worry at night about the cancer. He feels like that's fine. But what he's worried about is being able to swim this summer, because he has a central line. He's really, really freaking out about the water getting in the central line.” And so I was like, "Oh my gosh, absolutely."

So we talked about that, got it really properly dressed and covered it up really good, and they sent me a picture of him swimming maybe a month later. It was such a great feeling, and here I am, over two decades later, talking about it. It's just one of those things, that it definitely comes full circle when you think about the fact that he cares about swimming. That's what he's motivated by. And everything centered around, how do we get that to work?

JOHN DRISCOLL: What's exciting about that is that, we often get wrong in healthcare what Dr. Paul Farmer calls accompaniment. His point is simply, there's too much of the sending of the patients all around from one place to another, and that as caregivers, care providers, care coordinators, our job is to accompany the patient along their journey. That's what healthcare gets wrong, and we believe we get right more often than not at CareCentrix.

What we also try to make sure of is, while accompanying that patient, we tie what we want to do and what's best for the patient to what they care about. Because if we don't do that, we're failing to again, we're missing one of the great superpowers, which is what people's hopes and dreams are. When we can tie those to what we need to get in healthcare, it really, it's a true healing moment. So Dr. Rishi, that's a wonderful memory. I'm not going to steal it, but I am going to use it.

RISHI DESAI: I appreciate that. That's very kind of you. I think maybe then, what I'd like to leave our listeners with is your advice for folks that are coming out, especially at this time, with COVID-19 being such a dominant thing in people's mind space. What would you say to someone that's just starting up in their clinical life, or even thinking about going into clinical medicine at any level? What suggestion or advice would you have, given what you just said about thinking about the patient first?

JOHN DRISCOLL: I think it's to not let the system, the medical industrial complex, beat the humanity out of you. I read a really interesting study a few years ago that was looking at how little time internists spend with their patients, and how the patients perceived it. What was interesting was, where the doctor made eye contact and put their hand on the patient, the patient actually thought the doctor was spending more time with them.

It is a painful reminder that the medical industrial complex, managed care, hospitals, scheduling, it's easy to sort of get on the Habitrail of activities, and miss what drew you into healthcare back when. But I've got to say, hanging onto my idealism and belief that the system can change and that people matter has mattered in every job I've had in the last 30 years, and has made it a lot more fun to do the stuff I've done, and has lifted up patients and doctors. I think for those starting off in their medical careers, just hang onto your ideals and your heart, and you'll be just fine.

RISHI DESAI: I appreciate that. I think that's a really good note to end on. Having that come from someone that's seen so much like yourself, I think that carries a lot of weight, so I appreciate you saying that.

Thank you so much for joining us today. I'm Dr. Rishi Desai. Thank you for checking out today's show. Remember to do your part to flatten the curve and raise the line. We're all in this together.