Reimagining the Future of Health Care: Chief Innovation Officer of UPMC Dr. Rasu Shrestha on Design Thinking and Innovation

Reimagining the Future of Health Care - Chief Innovation Officer of UPMC, Dr. Rasu
Shrestha on Design Th inking and Innovation

[Music]

Female : Welcome to Conversations on Healthcare with Mark Masselli and
Margaret Flinter. A weekly show where we speak to the top thought leaders in
health innovation, health policy, and the great minds who are shaping the
healthcare of the futur e. This week , Mark and Margaret speak with Dr. Rasu
Shrestha, Chief Innovation Officer at the University of Pittsburgh Medical Center
and VP of UPMC Enterprises, the innovation branch of the organization. He is
also a courtier of Health Datapalooza, a go vernment and private industry
consortium dedicated to advancing health technologies that will improve
hea lthcare. Lori Robertson also checks in, the Managing Editor of FactCheck.org
looks at mis statements spoken about health policy in a public domain sepa rating
the fake from the facts . W e end with a bright idea what’s improving health and
well - being in everyday lives. If you have comments, please email us at
[email protected] or find us on Facebook or Twitter, we love hearing from you.
Also find us on i Tunes or Stitcher and please feel free to leave us a review. Now
stay tuned for our interview with Dr. Rasu Shrestha on Conversations on
Healthcare.

[Music]

Mark Masselli: We’ re speaking today with Dr. Rasu Shrestha, Chief Innovation
Officer of the Uni versity of Pittsburgh Medical Center , UPMC and Executive Vice
President of UPMC Enterprises. Dr. Shrestha is Chairman of the HIMSS
Innovation Committee and is co - chair of the Academy Health's Health
Datapalooza, a consortium of government and private secto r health industry
leaders committed to leveraging technology to advance healthcare. He was
named the Executive of the Year by Healthcare Dive and was named top
healthcare innovator by InformationWeek. Dr. Shrestha received his medical
degree from CCS Uni versity in India, his Fellowship in Informatics at the
University of London and his MBA from the University of Southern California. Dr.
Shrestha, welcome to Conversations on Healthcare.

Dr. Shrestha : Thank you, it’s a pleasure to be here.

Mark Masselli : UPMC is a $ 16 billion a year integrated payer provider health
system and it delivers care to three and a half million people in over 30 hospitals
and employees 80,000 people, wow , that’s a pretty big footprint . Y ou ’ve stated
that your mission is to rei nvent the future of healthcare , I’m wonder ing if you
could share with our listeners more about the culture of innovation at UPMC.

Dr. Shrestha: Yeah, I truly believe that [inaudible 00:02:31] culture eats
strategy for breakfast . W hat’s interesting when you’re part of a team that really
drives innovation forward and has the capability of leveraging an asset as

Reimagining the Future of Health Care - Chief Innovation Officer of UPMC, Dr. Rasu
Shrestha on Design Th inking and Innovation
powerful as UPMC , you get to be able to really cultivate that culture of innovation
at the very grass - root levels . A lso since both bottom - up as well as a top - down
approach, what we’re trying to do at UPMC and at UPMC Enterprises is to really
capitalize on this large organization , w e’re the largest employer in the state of
Pennsylvania with 80,000 employees. We’re also a large payer organization w ith
over 3.4 million lives that are being covered , and we’re trying to capitalize on
that. It’s really important for us to not just throw darts behind these buzzwords
but really to figure out what are some of the core unmet needs that we ha ve in an
organi zation as large as UPMC that in many ways is also representative of the
rest of the health system and healthcare as we know it more broadly of the
challenges around integrating data and liberating data and s ome of the
challenges that we know around accessi ng data and l everaging data that really
get into insights that will make a difference in the lives of these patients . T he root
of all of that really is to get that culture right , to make sure that we’re able to truly
understand not just specifics of the w hat, but also the why , and I think that’s what
we’re really trying to do here at UPMC.

Margaret Flinter: Well, Dr. Shrestha, you and your teams have figured out this
issue around culture acknowledging . Th ere can be something of a culture clash
betwee n m edical professionals who are so well - trained and adher ing to
evidence - based practices and the health industry entrepreneurs that maybe are
see ing a vision of what might work. Y ou’ve been engaging frontline clinicians in
your designed work which is so crit ical , c an you talk a little bit about the design
thinking approach that you use at UPMC, what I know you’ve called the living lab
for innovation . I f you ha ve a example or two of innovations that have come
through this process, I think our listeners would really enjoy hearing about them.

Dr. Shrestha: Yeah, I really believe that in healthcare , it’s important for us to take
a step back from just this business that we’re in. W e’re so busy trying to “fix
healthcare” and I think it’s important for us to just acknowledge the fact that hey,
look th ere’s this culture clash that’s happening really across the board in
healthcare and it’s something that I think we really need to acknowledge first and
to actually address that challenge. On one end of that culture c lash are
traditionalists and clinicians and researchers and scientists . I’m a clinician by
background and we’re trained to go with the tried and tested and evidence - based
guidelines and best practices in clinical protocols and that it’ s actually a really
good thing because that’s how medicine has grown to be what it is today based
on strong, scientific and academic rigor.

The other end of that clash; however are entrepreneurs and in novators and
technologists who then were coming in and saying hey, here’s this brand new
way of doing things, trust us it will work and bam , the cla sh really happens at that
point. W hat we’ve been doing in healthcare is we go out and have a request for
proposal, we purchase a software soluti on. We have a go - live event and that ’s
maybe perhaps the first time that phy sician gets to interact with that piece of
software and that’s just wrong on so many different levels . W hat we’re trying to

Reimagining the Future of Health Care - Chief Innovation Officer of UPMC, Dr. Rasu
Shrestha on Design Th inking and Innovation
do is really to turn that around on its head and saying, yep , th ere’s this culture
clash th at’s happening . T he way to really navigate that is to make sure that the
clinicians , the end - users, the patients are at the very beginning, not at the very
end, but really at the very beginning of that process and enhance the embraces
this methodology aro und design thinking where we start first with empathy.
We’re ab le to really have these design thinking exercises and talk about what
they want built, but really about what their pain points really are . T hat’s when
you start really getting into the very c rux of those challenges that we’re facing on
a day in, day out basis .

W hen you then sit down and go through this iterative process of designing and
building solutions and coming up with prototypes in rapid cycles , this method of
fail - fast that we talk so fondly about the m becomes real and you’re able to scale
th os e successes and learn from those failures and really get to a point where you
can truly capitalize on those assets that you ha ve those clinicians, those patients
and really come together as a team around this process. So that’s just how
we’re really pushing for some of our innovations forward, so whether it’s in areas
of mental health or whether it’s in areas of cancer care , many - many specific
examples of how we’re really tryin g to capitalize on t hat design thinking process ,
leveraging those clinicians and those patients as partners, not just building the se
solutions but helping grow th ese solutions into really successful products and
companies even.

Mark Masselli: Dr. Shrestha as you were talkin g about that paradigm , we just
had Dr. Eric Topol on our show, a cardiologist, geneticist but also someone who
really gets it about being engaged with these transformations with the population
obviousl y and engaged in the All of Us initiative , but he is ta lking to us about this
pivotal moment we a re , the opportunity to reboot healthcare towards a more true
personalized medicine looking in the AI area, machine l earning g enomics and
others . You also stated that we’re at an important inflection point that thi s is a
new way of innovations, not necessarily by creating new gadgets or things , but
it’s often more about rethinking the existing health paradigm and you really just
talked about that very nicely, I think. How ready do you think the country is for
this new level of engagement?

Dr. Shrestha: Well, you mentioned Eric Topol and he is such a brilliant individual
and is a visionary on many fronts. We had an exercise that we did that
culminated in TweetChat as well as really interesting webinar and number o f
other pieces that are coming out , what we’re calling the rise of genomics ,
#RiseofGenomics. Really we talked about a lot of things that are coming
together to basically facilitate innovation such as the rise of genomics where you
see consumers really le aning in and embracing the likes of genom ic testing type
capability that a re now directly accessible to patients and consumers , that
physicians are now really using to help them in making really life changing
decisions , but also to help them have meaningfu l conversations with their
patients and others. T hat’s just one example and you talked about

Reimagining the Future of Health Care - Chief Innovation Officer of UPMC, Dr. Rasu
Shrestha on Design Th inking and Innovation

the inflection point and we really are at an inflection point in the industry and I
think it is ours to lose whether you’re small entrepreneurial startup or you ’re
larger health system like us at UPMC, or you ’re an outsider like Amazon and
others that are sort of looking to come into healthcare and “disrupt healthcare.”
We’ve g ot three massive dynamics and [inaudible 00:10:0 2 ] almost hitting us.
One sort of thi s way of digitization we’re more digital today tha n we’ve ever been
in the past, m ore so even in the last decade with meaningful use and an other
sort of initiatives that have really pushed us forward in the embrace of digital and
that’s a good thing. The second is this move from volume to value and there is
this movement from talk to action, and the third really is technology whose time
h as come and capability such as genomics and machine learning and AI that
have really come to a level of maturity and the right price point today that really
allows for us to embrace these capabilities and these three dynamics and take it
to the next level. I do think the time is right, it’s more right today than it’s even
been in the past, we’re in 2018 t oday and I remembe r you know, decade or more
ago used to talk about 2020 that’s the future. Well, the future is here , and it’s
time for us to really capitalize on all of this.

Margaret Flinter: Well, that’s great Dr. Shrestha. One thing I really appreciate
about some of your writing and comments is that that you cautioned against
overusing buzzwords and catch phrases which is kind of endemic in healthcare a
lot of the time . Y ou’ve used patient - centered care a s a n example of a phrase of
course, we all believe that that’s wh at we’re doing it certainly sounds wonderful .
T hen we went and created technology around the patient provider and to change
it, maybe actually really interfered with care that patients would experience as
truly centered with them at the center of it. I know that you’re very committed to
this principle that the patient has to be at the center of any design enterprise.
Tell us about that process at UPMC Enterprises and again if you have some
examples of how patients have really informed the projects that you’re
undertaking there with your innovation team.

Dr. Shrestha: I think it’s really important for us as an industry really to just stop it,
stop with paying lip service to , hey let’s have a patient - centered approach to
care . I do think clinicians bel ieve this in their core that what they’re doing is
practicing patient - centered care and they a re. The problem is that the solutions
that we’ve created for them, the system that we’ve built really doesn’t cater ed to
a true patient - centered approach . I t’s very systemic in the way that we’ve
created these solutions focused on billing and documentation, getting a lot of
these transactional components done, getting this volume throughput through
your organization . We have an opportunity today to really reinve nt how we’re
looking at the patient - centered care .

On e approach that we’re taking at UPMC is to really engage these end use , I
m entioned the process of design thinking earlier but engage them in the very
design of the solutions but re - architect the specif ics of even the workflow and the

Reimagining the Future of Health Care - Chief Innovation Officer of UPMC, Dr. Rasu
Shrestha on Design Th inking and Innovation
incentives around these patients that really need to be part of the journey. It is
for them and with them that we’re building these solutions, not just at them. O ne
example of this is in the lots of challenges in mental h ealth, there are two big
challenges that we see – one is stigma and the other is access to expert mental
health resources and we have an opportunity to redesign of the se solutions . The
way that we did this was to really co - create a set of solutions with a company
called Lantern Health that we invested into and we’re building these set of
solutions that really puts all of these capabilities directly in the hands of
consumers through mobile devices and coaching capabilities again directly
accessible to them . I t’s amazing how innovations like those are really
transforming the way the patients are now being empowered to really lean in and
be part of a broader care team that includes themselves and that’s just one
example of how we need to really rethink this p aradigm and truly engage patients
in the redesign of the solutions that we’re building.

Mark Masselli: We’re speaking today with Dr. Rasu Shrestha, Chief Innovation
Officer of the University of Pittsburgh Medical Center and Executive Vice
President of UP MC Enterprises, the entrepreneurial division of UPMC. Dr.
Shrestha is co - chair of the AcademyHealth's Health Datapalooza. Rasu, we’ve
had many of the Datapalooza influencers on the show, Lisa Simpson from the
AcademyHealth , Aneesh Chopra and others. Tel l us what’s up with the
Datapalooza gathering this last year. What was all the buzz about?

Dr. Shrestha: A s co - chair of Datapalooza, I was able to really have an
opportunity to be in the driver’s seat with other leaders and as we enter into
2020 . I t’s different today than when Health Datapalooza fir st came into existence
now nine years ago. O ur country is at a different trajectory altogether, a lot of the
data has been liberated but at the same time a lot more yet needs to be done
with the data. It’s not just about having access to the data but actually making
sure that we’re able to see multiple different sectors and segments c ome
together to really build the solutions that we need . H ealth Datapalooza was that
platform where you saw public sector com e together with private sector come
together with experts around policy with investors , with folks from the patient
community and provider community really come together and say, alright how do
we really make it work? T remendous conversations and there ’s a lot more yet
that we’re planning for going into 2019 to capitalize on this big wave that we’re
seeing around all these diff erent entities coming together.
th
Margaret Flinter: Well, w e’ll do an advance shout - out happy 10 anniversary ?

Dr. Shrestha: Tha nk you.

Margaret Flinter: Hard to believe. So you know, you’ve referenced this new
trend of non - traditional healthcare industry entities coming into t his space.
Google has its [inaudible 00:1 6 : 13 ] Sidewalk Labs researching ways to improve
population he alth. We see companies like Aetna and CVS forming mergers to

Reimagining the Future of Health Care - Chief Innovation Officer of UPMC, Dr. Rasu
Shrestha on Design Th inking and Innovation
actually meet patients where they live. We ha ve the new ABC venture with
Amazon, Berkshire Hathaway, Morgan Chase promising to disrupt healthcare
and bring cost down. In this climate of accele rated innovation but also promised
disruption from multiple sectors, what has you most concerned or perhaps most
excited about where this is going to take the healthcare industry in the United
States?

Dr. Shrestha: Yeah, I’m actually really excited about where things are right now
and these “outsiders” like Google and Amazon and others really trying to get into
healthcare and solve for some of the biggest challenges health. You also got
more of the insiders or perhaps non - traditional ins iders like C V S an d Aetna and
others saying all right, there is a way that we can actually solve for some of the
biggest challenges . In many ways that’s what we’ve been trying to do at UPMC
and we’ve been trying to take a very non - traditional Silicon Valley - ish approach,
c all it that , in the very heart of a very traditional healthcare organization where
one of the largest academic medical training programs in the country with a lot of
science and academia and rigor behind a lot of the entrepreneurial business bets
that we m ake an d these term sheets that we pull together and these companies
that we create . T hat’s what we’re trying to do is to say, hey look, how do we take
a very non - traditional approach to this? W e do this a lot of times with the right
partners as well . It’ s really encouraging to see across the industry including from
outside of healthcare that are coming in because look I do think it’s about time
that we do this. We’re $ 3.5 trillion industry . C osts continue to accelerate and
access to care is not where it needs to be . W e in many ways are ourselves
challenging the status quo and ourselves taking very non - traditional approaches,
so I’m excited.

The only concern that I would throw out at this stage really is that it needs to be
done with a level of purpose and not just with a frenzy to make a splash in the
media or make a change happen. It needs to be sought through that really is
backed by strong academic and scientific rigor, but is also backed with a mission
in mind to really make massive changes in the way that our healthcare industry’s
trajectory is actually moving . H ow do we think about sort of newer business
models that need to exist ? How do we think about how we incentivize , not just
the physician communities but also the patient and the consumers out there to
really turn the notion of healthcare on its head and move it from where it’s been
today which is really about sick care to where it needs to be which is really about
wellness and thriving and staying out of hospitals and sort of disrupting the
current paradigm. E xcited , but at the same time concerned that we don’t do this
in a friendly manner with a level of urgency that it calls for but also with strong
backing up scientific rigor.

Mark Masselli: We’ve been speaking today with Dr. Rasu Shre stha, Chief
Innovation Officer of the University of Pittsburgh ’s Medical Center and the
Executive Vice President of UPMC Enterprises. You can learn more about their
work by going to enterprises.upmc.com or you can follow him on Twitter

Reimagining the Future of Health Care - Chief Innovation Officer of UPMC, Dr. Rasu
Shrestha on Design Th inking and Innovation
@RasuShrestha , a lso at #upminnovates. Rasu thank you so much for the
exciting work that you’re doing. Y ou’re such a bright light in the healthcare
environment and we appreciate you joining us on Conversations on Healthcare.

Dr. Shrestha: Absolutely, thank you very much f or having me here.

[Music]

Mark Masselli: At Conversations on Healthcare, we want our audience to be
truly in the know when it comes to the facts about Healthcare reform and policy.
Lori Robertson is an award - winning journalist and Managing Editor of
F actCheck.org, a nonpartisan, nonprofit consumer advocate for voters that aim to
reduce the level of deception in U.S. politics. Lori, what have you got for us this
week?

Lori Robertson: President Donald Trump implied that his administration’s funding
to fight the opioid epidemic had cau sed the numbers to come way down . T he
most recent data we have on opioid - related deaths which was still rising and
prescriptions for opioids , which have been declining in recent years predate the
funding the President tou ted. During a campaign rally in Nashville, the President
said “We got $ 6 billion for opioid ” adding “ and the numbers are way down.” The
$ 6 billion was for fiscal 2018 and 2019. At the end of March, c ongress
appropriated $ 3.6 billion of that for fiscal 2 018, which ends September 30th.
When we asked the White House about Trump’s claim, it referred us to figures
primarily on opioid prescriptions. The latest figures; however, only encompass
2017, Trump’s first year in office and before the funding the Pres ident cited was
even appropriated.

Overall, dispensed prescriptions for opioids have been declining in recent years.
Total deaths from opioid overdoses , which numbered more than 42,000 people in
2016 , have continue d to increase. Latest figures from the Centers for Disease
Control and Prevention showed that the number of dispensed prescriptions
peaked in 2012 and then began to decline. The rate of 1 8 .3 prescriptions per
100 people in 2012 was down to 66.5 per 100 people in 2016. Figures including
2017 c ome from a report by IQVIA Institute for Human Data Science. That report
found that the volume of opioid prescriptions has been declining since 2011.
One fact that report cited was more states adopting laws on restricting
prescriptions such as the volume or number of days opioids can be prescribed to
new patients and that’s my f act c heck for this week. I am Lori Robertson,
Managing Editor of FactCheck.org.

[Music]

Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country’s majo r political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you would like

Reimagining the Future of Health Care - Chief Innovation Officer of UPMC, Dr. Rasu
Shrestha on Design Th inking and Innovation
checked, e - mail us at chcradio.com, we’ll have FactCheck.org’s Lori Robertson
check it out for you here on Conversations on Healthcare.

[Music]

Margaret Flinter: Each week, C onversations highlights a bright idea about how
to make wellness a part of our communities and everyday lives. When it comes
to walking the walk , Chester County, Pennsylvania is on it. To celebrate National
Public Health Week , c ounty Health officials decided to issue a challenge to
members of their community to log a collective billion steps last year .

Jeanne Casner : Started with a National Association of Counties O fficial s
C onferenc e in which they were announcing a national competition to improve
health outcomes in cities and counties . W e applied for that while we were also
trying to introduce more physical activity into our health department initiatives.

Margaret Flinter: Jeanne Casner, Director of the Chester County Health
Department says they launched the program WalkWorks ChesCo ! creating a
website for county residents to log their daily steps to join w alking groups, issue
challenges and get entire families and neighborhoods in volved with th is simple
goal, walk for better population health.

Jeanne Casner: A model for getting individuals up and walking that takes
multiple approaches and hopefully start s to inspire that next generation to be
walking was something simple.

Margar et Flinter: Communities, schools, companies all engaged in walking
challenges and it led to far more people participating throughout the county.

Jeanne Casner: W e actually have a website where people can go and check
how many steps and how many walkers and look at competition. That’s really
what starts to spur it . T hen having a couple of trusted organizations participate in
a walk and putting a little visibility , getting the newspaper out there to write a little
piece on it. It doesn’t have to be coun ty - wide and that’s the beauty of walking.

Margaret Flinter: In just six months, some 3000 participants were able to log
over a billion steps having reached their goal far more easily than they originally
thought. Casner says since it’s a two - year progra m, they actually had to
increase their goals to keep people walking.

Jeanne Casner: L ast year w e accumulated about 1.7 billion. O ur goal was 1
billion, so we exceeded that and we reached about 2800 walkers. This year’s
goal is to walk accumulative of 5 billion steps. We took a look at the data and
said we’ve a lot of steps, we don’ t have enough people, s o in a county of 515,000
plus residents so we pushed it up to 5000.

Reimagining the Future of Health Care - Chief Innovation Officer of UPMC, Dr. Rasu
Shrestha on Design Th inking and Innovation
Margaret Flinter: Their program earned early praise from the Aetna Foundation
and they’re now in the running for clinching the national competition. A
community - wide effort leveraging the power of public and government entities to
engage the community in a collective health and wellness program . C reating a
user - friendly website for p articipants to engage with one another , making it fun,
yielding an increase in healthy exercise across the population; n ow that’s a bright
idea.

[Music]

Mark Masselli: You’ve been listening Conversations on Healthcare, I’m Mark
Masselli.

Margaret Flint er: I’m Margaret Flinter.

Mark Masselli: Peace and health.

Female : Conversations on Healthcare is recorded at WESU at Wesleyan
University streaming live at chcradio.com, iTunes or ever you listen to podcast s .
If you have comments, please e - mail us at [email protected] or find us on
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