A Clicks & Mortar Future for Healthcare - Dr. Marc Harrison, Healthcare Executive and Author of Possibility Unleashed

Shiv Gaglani: Hi, I'm Shiv Gaglani, and today I'm happy to welcome Dr. Marc Harrison to Raise the Line. Dr. Harrison has had an impressive career as a leader in healthcare, spending more than a decade at the Cleveland Clinic before serving for six years as president and CEO of Intermountain Healthcare in Utah, considered one of the nation's most innovative health systems for its focus on wellness and addressing the social determinants of health. 

Dr. Harrison recently began a new chapter in his career by starting what he describes as a revolutionary healthcare company with venture capital firm General Catalyst that's designed to promote health, wellness, access, affordability, and equity. I also want to note that General Catalyst is a major backer of CityBlock Health, whose CEO, Dr. Toyin Ajayi, was a previous guest on the show. 

So Marc, thanks for taking the time to be with us today. 

Dr. Marc Harrison: It's great to see you, Shiv, and great to be with you.

Shiv: Great. Now, our audience doesn't know, but I've obviously been following your career for a while now because I lived in Park City for a few years, and we ran into each other randomly at the club we share, Silver Mountain Health Club, where I think you were doing a five AM swim. Before I get into your esteemed career in health care, I did want to just say that I admire

your focus on your own personal health and well-being, and wanted to ask you a bit about what you're training for now because you’ve completed multiple Ironman races.

Dr. Harrison: I'm happy to talk about that and just so our listeners are clear, our health club's not super fancy. It sounded very upper crust there for a second. It's functional, wouldn't you say, Shiv? It gets the job done. 

Shiv: Yeah, totally. 

Dr. Harrison: So, I've loved sport my whole life. I think I probably started training regularly when I was twelve or thirteen years old. I'm pretty convinced it is a non-pharmacologic treatment for my bad ADHD. I think it probably takes the edge off and helps me focus. 

It also has just been a pleasure. My best friends are the folks who I've met through sport.  I'm training always for something. I think my next race is in a couple of weeks. I'm mostly doing local races this summer and last year was a big year doing Kona in the fall. But this year, I think it's mostly about getting some running speed back and just enjoying the local scene. I really enjoy it. 

Probably the best part is getting to train with lots of friends around home right now and maybe we can go for a ride or a run together. It'd be really fun. I was just up in Boise last weekend with one of my oldest friends. I think we both needed a couple of days off after the weekend because we swam, we ran, we mountain biked, we lifted weights, we drank some beer, we talked, we caught up. It was just fabulous. So, sport is simply a vehicle to take good care of your body, but also take good care of your soul, I think.

Shiv: I couldn't agree more and I think there are a lot of very successful people like yourself who pursue these activities. I think, one, because it takes a lot of drive to do both. But two, it's, as you said, non-pharmacological therapy for all sorts of issues. 

Dr. Harrison: All sorts of things. 

Shiv: And some of the best ideas, I find, come from those long runs and long rides.

Dr. Harrison: Yeah, I would agree and it keeps me married. It’ll be thirty-three years next week, and my wife will often say, “You need to go for a run. So why don't you get out there?” So, it's good for all kinds of things.

Shiv: Congratulations in advance on that milestone. So, switching gears from your achievements in sport and reasons for sport, let's hear more about what got you interested in medicine and then pediatric critical care specifically.

Dr. Harrison: I've always loved medicine. I came from a medical family. My granddad was a surgeon. My dad was a surgeon. My mom was a social worker and I guess helping professions were always what we did. In college, I was a river guide for a lot of it. I was a safety boater for a rafting company and after a summer sleeping in my truck with wet neoprene, I was like, “I probably should go back to school and study really hard” and decided to go to medical school.

Then in medical school, I actually raced as a not very good pro triathlete for a season or two. I did a bunch of obscure offshoots of the sport like canoe triathlon, and I did off-road racing and stuff, and again, I was marginally successful, so thought maybe this is a better hobby than a profession. 

There’s two things I like the most about medicine: I love the puzzles and I like the intellectual part of it. It's like seeing a person and listening to them and trying to figure out what was going on, and align with that. The second thing is I love people's stories. I'm a really avid reader. I'm an avid listener. I love people's lived experience, and the privilege of being let into somebody's life in the most intimate, sometimes happiest, sometimes saddest times is just incredible. I got a lot of pleasure out of it, and I hopefully helped a lot of people. So, I think that was the medicine part. 

As for pediatric critical care, I wanted to be a pediatrician mostly because I like the other pediatricians. I like kids just fine, but the family dynamics were super interesting and I've always had sort of a... I'm not sure, maybe a mission-driven side and I've always been interested in the underdog and kids have always been systematically at risk and underserved.  I initially wanted to go into pediatrics to sort of fight that fight for the kids, and I thought that when I met my wife -- she was an intern and I was a fourth-year medical student -- that we would end up in a little town in Montana, being the town pediatricians and working with the local school district and it sounded kind of romantic and service-oriented and humble and simple. 

My problem was, A, I wasn't very good at general pediatrics and B, I didn't like it very much.  I'm not like a big sleep, toilet, training, and biting expert. Nor did I really want to be. My wife is really a phenomenal general pediatrician. She's really good. So, I was going to leave pediatrics altogether and first went to the emergency department for rotation. I loved it and then I realized the person who saved the bacon of the people in the emergency department was the intensivist. 

I've always been the person that wants to run towards trouble. I don't want to run away from trouble and so it was magic for me. I love the ICU. I love the teamwork. I love the intensity and clarity of decision-making. I love the physiology and pharmacology. Love the people, and it was just a great, great, great experience.

Shiv: Yeah, clearly. One reason I love to ask that question is personally, because I'm back in med school now after ten years of taking a break to start and build and sell Osmosis, but also because so many of our listeners ask us about zig-zaggy career paths. It gives them a sense of all the things you can do if you are fortunate enough to have a long enough lifespan to then pursue all those interests.

Dr. Harrison: So Shiv, do you have a sense for where you're going with your medical school career?

Shiv: Thanks for asking that. As you were mentioning, one reason you were attracted to medicine is asking people about their lived experience and I love the brain and neuroscience That's what got me into Osmosis and learning science. How do people learn and retain and how do we change people's behaviors? One of the main reasons I've gone back to Hopkins -- because I was thinking of transferring for a while to NYU or some other place to go back to med school -- is they have some of the leading research both in brain-computer interface and AI, as well as psychedelics because I think there's a lot of promise in both of those for the next ten, twenty years or so, at least.

Dr. Harrison: The psychedelic thing is really interesting. About three and a half years ago, when I was super sick with myeloma, and I had worked my way through all of the conventional chemo and immunotherapies, and then a bone marrow transplant that failed. While I was trying to get into a clinical trial -- because I was out of options and getting sicker by the day -- my biggest fear as I was facing my mortality was the sense that I wasn't done yet. I had more to do, and I felt very incomplete. I was nervous about my kids, who were young adults at the time and of course, my wife, who I didn't want to leave prematurely, although she would have been okay. 

But I started reading about psychedelics and this idea of terminally ill people, which I was at the time. The apparent ability of psychedelics to give people a better sense of how they fit into the world was fascinating to me and since then, as we both know, that field has really just taken off and I think probably is largely untapped in terms of its both therapeutic as well as palliative uses. So, I think you're onto something big there.

Shiv: I'm glad you mentioned that. Thanks for sharing a personal story about what got you interested in this space as well. Roland Griffiths is the professor at Johns Hopkins who did seminal work in patients with cancer and helping them reduce death anxiety. Unfortunately, he now has terminal cancer himself. His collaborator -- Dr. Manish Agarwal at Sunstone Therapies who we've had on the podcast -- is doing the first clinical trial of having patients with terminal illnesses and their caregivers both experiencing psilocybin journeys to see if that can help reduce the anxiety of both parties involved. 

Dr. Harrison: That's really interesting. Do they do their journey together?

Shiv: I don't actually know the format, but I think I'll be seeing Manish at the Psychedelic Science Conference in Denver. I think that's how it's structured. So, I'll ask him a bit more about that.

Dr. Harrison: That's fascinating, because, you know, one person isn't terminally ill. The family actually is affected so profoundly in every possible way. So, that's really fascinating. That sounds like it's very promising.

Shiv: Totally. 

Dr. Harrison: And I'm sorry that your mentor is not doing well.

Shiv: Yeah, no.

Dr. Harrison: We all die eventually, but you know, it's unfortunate when somebody who's given so much...I bet he has a lot more to give.

Shiv: Yeah, and I'm sure as you know, as a leader -- and having cultivated many mentees -- the life work continues through them, which is great. So, let's talk about your journey as a leader, because it's no small feat what you accomplished at Intermountain. Maybe you can give us a sense of what Intermountain was like when you joined, and then you led it through the COVID pandemic. Maybe you can provide some of the highlights.

Dr. Harrison: So, look, Intermountain was terrific when I got there and it's long been a mission-driven, high-integrity organization led and governed by amazing people. It also was pretty conventional when I got there, in some ways. It was forward thinking in terms of paying attention to quality; forward thinking in terms of being excited about the payer provider model and being paid to keep people well; forward thinking and having a really great medical group, and also having its own health plan; but it also was pretty slow to move. And one could argue that there are really good parts about that, and I would accept that. But we also were a bit inwardly focused. 

I think one of the great examples of that is when we looked hard at the quality data for the system -- quality was on the top of everyone's mind, as was safety -- but we were only measuring ourselves against ourselves to a large extent. We were inwardly looking, and I changed that really quite dramatically. Also, with the help of others, I instituted an operating model that relied on communication from the front lines up on a daily basis with a tiered huddle system that ended up being sort of the backbone of how we made change. 

On a daily basis, a couple thousand huddles would occur culminating in a visit with the leadership team at ten o'clock every morning and we got to hear every day how the system was functioning and where it wasn't functioning and make decisions as quickly as possible to try and improve that. Actually the person who really was the architect and executor of that is a gentleman named Rob Allen, who was my chief operating officer, who is now the CEO of Intermountain. 

I think the other things that we did were we kept on driving value, and we got up to about 40% of the total revenue of the system in a fully prepaid model, a capitated model, and that allowed us to make lots of really interesting decisions about keeping people well instead of just taking care of them when they were sick and driving low-cost care. 

Then, finally, we grew. One of the very conventional things is that as much as I immensely respect the folks who came before me at Intermountain, there was an expectation that we would “never grow until our care model was perfected.” And I just said, that's ridiculous because no one's ever perfect and that's an excuse not to grow and if we are doing things really well, we actually have an obligation to share that more broadly and to lead the industry. To that end, we grew from really one state with a bit of activity in another state into a seven-state system in a six-year period and grew from a $5 billion company to an almost $15 billion dollar company all while performing very, very well. 

I'd say the highlight of my time at Intermountain, in addition to working with really remarkable people, was the opportunity to be a wartime CEO. And in this case, the war was the pandemic.

The chance to work with former competitors who became our collaborators; to see the innovation and leadership that came from the front lines; to speed up processes; to take better care of patients; to fully embrace the digital world and alternative sites of care was thrilling. At the same time, there was the impact on human beings -- from physical illness, from behavioral health problems, from isolation -- that was horrendous to see, and we had the opportunity to try and do a good job in the face of all that. 

I think arguably Intermountain did a spectacular job. What a privilege. I'll never forget that opportunity. As it happens, that's also a privilege. I was on the back end of my CAR T-Cell therapy and I needed to be isolated because I was profoundly immunosuppressed at that time and very much at risk for COVID, in the pre-vaccination era in particular. So, leading remotely from a timing standpoint worked out great.

Shiv: That's incredible. I mean, if anybody was to tune into this and just hear about that six-year growth in terms of people you've covered -- one state to seven states -- and the three X in revenue, they'd be impressed just by that. But to know that you personally were going through the myeloma and that half to a third of that tenure was during COVID is even more impressive. 

I like the wartime CEO reference. I'm sure you've read the book, The Hard Thing About Hard Things where that's referenced as well.

Dr. Harrison: Yeah. Look, at General Catalyst, I have an opportunity to work with Ken Chenault who's the chairman. I think his actions at a number of points during his career at American Express... he was sort of the ultimate in that. If I did a quarter of as good a job at Intermountain as Ken did at American Express, I would count that as a success.

Shiv: Yeah, incredible. So, let's talk about General Catalyst because we were all wondering what was next as you wind up your time at Intermountain. I know you're in stealth right now, but what can you tell us about that decision to join GC and what you're working on now?

Dr. Harrison: So, I have ultimate respect for Intermountain. It is an organization that is at scale. I mean, there's 60,000 employees now, there's thirty-three hospitals, there's hundreds and hundreds of care sites. It's a big operation and I think it is changing as fast as an operation of its size can change. That said, it's not fast enough to hold the leadership role that we need someone to take in terms of demonstrating what the future of healthcare should look like. I think it should be accessible, it should be affordable, it should be of high quality, it should be consumer-centric, and it should be a combination of the digital and legacy world. It’s a clicks and mortar future, as we like to say.

I see health systems being systematically disintermediated by certain payers, as well as by some tech companies who are eager to take the easy stuff -- the high margin, relatively low-cost stuff -- and leave the health systems with really complex, sick, and often very poor patients. They're not going dry up and blow away, but they're distressed, as you know. Half of them are running in the red right now.  I want to change that, and I needed a speedboat to change that.

Ken Chennault, who I mentioned, the Chairman of GC, and Hemant Taneja, the CEO, are two incredibly high-integrity and brilliant people, and they came to me and said that GC is on a journey to change healthcare through this health assurance initiative and that really translates into population health. It's powered by collaboration -- radical collaboration that I've called ‘partnerships’ in my career previously. They said, “Come and join us. Let's do something amazing.” We talked for quite a long time. I was resistant initially, because I was so happy at Intermountain, but it became apparent to me that there may be a platform at GC to make the kind of change that I believe needs to be made and do it at scale and quickly, and that's what we will do. 

I can't really say a ton more, but all those features -- access, affordability, equity, clicks and mortar, health system resiliency, et cetera -- will all be facets of it. One of the things that is public that will be part of our enterprise is this health ecosystem that we've created with now seventeen partnerships across three continents and four countries. We've got these health systems to be our innovation thought partners and collaborators as we deploy digital tools. 

We're very fortunate and privileged to work with these folks. They're well-led and they see that the future needs to be different and we'll be eager to work with them going forward with HATCO, as it's unveiled.

Shiv: Well, we're eager to hear more about what it is. 

Dr. Harrison: It's gonna be a great adventure, thanks.

Shiv:  Yeah, just the description is exciting. Hopefully, do you think later this year we'll hear more about it?

Dr. Harrison: Hoping, yes. That's the intention. I can't really say a lot more, but there are a number of things in flight right now that if we can land them, then we'll be out of stealth mode.

Shiv: Awesome, well, I'm excited for that. One thing then we can talk about, I'm sure, is your recent book, Possibility Unleashed. I’m an avid reader and it’s on my list. Can you tell us a bit about the book and about some of the lessons and advice you've put in the book that could be relevant to our audience?

Dr. Harrison: Yeah, I think there are really two theses to the book. The first really relates to this contentious world that we live in. Having public leadership roles in a time when a lot of business models are built upon polarizing the population is actually pretty difficult. What I've tried to do, and I think done reasonably successfully, is find common ground and to depoliticize the language that's used and also to systematically identify commonalities that allow people to work together who are unlikely bedfellows based on maybe what their politics are or how they make their living, et cetera. So, that's the first main point. 

The second is that as leaders, our job is to provide a place, a venue, for people to express their talents as fully as possible. The title of the book is Possibility Unleashed and that's in fact what I try and think about every day is how can I create an environment where people get to do their very best work. Within the guardrails of strategy and clear milestones, how do they get to run hard, run fast, be collaborative and do more in that context than they could ever do on their own? I think there's some pretty good examples of that in the book. 

I'm incredibly fortunate. There's a number of folks in there who were kind enough to be interviewed ranging from people like David Petraeus, who was kind enough to do an endorsement for the book; General Stan McChrystal, who wrote Team of Teams; Ginni  Rometty who ran IBM, and on and on. 

One of my favorite people, Bob Carey -- who was a governor, US Senator and Congressional Medal of Honor winner -- talked about some of his leadership experiences and point of view. So, I think it's a good read that gets you inside the heads of these people who have given their life to service and making change and leading others. And, so far so good. I think most people are enjoying it.

Shiv: Well, I'm excited to read it and I'll get back to you once I do with any takeaways I have.

Dr. Harrison: Please, and leave me a good review online. 

Shiv: Of course, of course. I always do that and we'll drop the link in our show notes for our audience.

Dr. Harrison: Please, of course, yeah.

Shiv: You mentioned at the beginning that you're an avid reader. One thing I always like to ask our guests is what are some of the influential books you've read?

Dr. Harrison: Oh my gosh. That's hard. So, I'm a somewhat indiscriminate reader. I like everything, really. I like nonfiction. I like fiction. I like older books. I like newer books. I loved the book, Endurance about the Shackleton expedition. That's like an old favorite of mine that I've read a number of times. The thing I loved about that was he was a complicated and not necessarily a great guy, but what an incredibly difficult situation he had with his boat and his team trapped in the Antarctic ice and having to winter over down there. And then the escape they made across the Southern Sea in open boats and everyone got out alive and essentially intact. An incredible feat of leadership that I just loved. 

There's a British author who you may or may not know. His name is Ian McEwan and his use of language is absolutely spectacular. There's a book that he wrote about a decade ago. It's called Machines Like Us that ends up being pretty prescient in terms of what AI and machine learning and the impact of robotics could look like in a very fictionalized setting. I love that book as well and read it relatively recently.

Shiv: Those are great recs. I will definitely plus one the Endurance rec. When I read that a couple years ago, one thing that stuck with me was that scene where someone was out trying to find food for his team or for the ship and I think an elephant seal broke through the ice and chased him. Whenever I go through hard things, I'm like, “Wow, at least an elephant seal or a walrus or something is not chasing me right now!”

Dr. Harrison: It was a leopard seal and he actually his guys would take turns running along the edge serving as bait for the leopard seal. I mean, that's teamwork! 

But anything by Ian McEwen I think you would love, and there's a really great book by the person who wrote The Martian and it's called Project Hail Mary.  I don't normally love science fiction but it is a terrific read.

Shiv: Fascinating read, I agree. Well, I want to be respectful of your time, so my final question for you has just two parts. One is, as I said, I'm back in med school. What advice would you give to me and other med students about approaching their careers, especially given all the things that are changing...not just from the pandemic, but now AI, as you mentioned?

Dr. Harrison: So, I'm a total optimist about medicine, to tell you the truth. This is a career and this is a profession that if you go back a hundred years, antibiotics didn't exist, right? Antibiotics really started to hit during World War II. The idea that radical change is happening is actually heartening to me, because in general -- although we've had plenty of medical misadventures -- things have gotten a lot better and they've gotten better for lots of people across the globe in any number of ways. 

I would say to people who are going into medicine, it's the best career of all time and there's nothing more sacred than taking care of another human being. I'd say, learn to be a lifelong learner, because things are gonna change fast. Plan on retooling and retraining a couple of times, because that's gonna be -- regardless of whether you're in medicine or other things -- what we're all gonna need to learn how to do. And most of all, have fun with it. I mean, it's just incredibly interesting, fulfilling, satisfying, endlessly fascinating. I'd say go for it. 

By the way, one of the things I love about this generation of doctors -- and our oldest child, Alex, is finishing his OBGYN residency at a safety net hospital in Cleveland and then he'll do a maternal fetal medicine fellowship -- Alex and his colleagues are much better than my colleagues and I, or my wife Mary Carol, ever were. They're going into this for all the right reasons. They know they're not gonna probably be rich or famous, but they're gonna be fulfilled. They're gonna earn a decent living, and they're going into this eyes wide open. So, my advice would be, go for it, and love it.

Shiv: That's wonderful advice to end on. So Marc, thank you so much for taking the time to be with us on the Raise the Line podcast, and more importantly, for the decades that you've contributed to patient care as well as leading large health systems, and now for what you're doing with GC, which we're excited to hear about.

Dr. Harrison: Thanks, my friend, and I hope to see you in Park City.

Shiv: And with that, I'm Shiv Gaglani. Thank you for checking out today's show, and remember to do your part to raise the line and strengthen our healthcare system. We're all in this together. Take care.