Datica Podcast

December 11, 2018

How MSOs Let Doctors be Doctors

In this podcast, we speak with Geeta Nayyar, M.D., M.B.A. about her experiences as the Chief Healthcare & Innovation Officer for Femwell Group Health, a management services organization (MSO). Dr. Nayyar shares her insights into how MSOs can drive performance improvement and “let doctors be doctors” by handling “the business side” of medical practice. We get an inside look at how Femwell is leveraging actionable information to fill gaps in care and optimize scheduling while improving patient satisfaction and practice performance under both fee-for-service and value-for-service models. Dr. Nayyar rounds out the discussion with a well-chosen pet-peeve and some sage advice.


Dr. Dave Levin: Welcome to Four by Four health sponsored by Sansoro health. Sansoro health integration at the speed of innovation. Check them out@wwwdotsansorohealth.com I’m your host doctor Dave Levin. Today I’m talking with Geeta Nayyar, M.D, MBA chief healthcare and innovation officer for Femwell Group Health, one of the largest management services organizations in the state of Florida. Her previous roles have included CMIO for AT&T, and board member of HIMSS. He does a nationally recognized leader in healthcare information technology. She was named one of the “Top 26 smartest people in Health IT” by Becker’s report and Med city news recognized her as one of the top 12 powerful women voices in healthcare innovation and on twitter. She’s a noted social media expert and blogs for the Huffington Post. She also wrote the foreword for a book I coauthored, although I note she didn’t list that on her resume. Welcome to Four by Four Health, Geeta.

Geeta Nayyar: Thanks so much for having me on Dave. I really appreciate it, and I don’t know how I left the book out. I don’t know how that happened. We’ll have to fix that.

Dr. Dave Levin: God, oh, it might be too late for that, but I appreciate it. Geeta, I’m going to ask you a series of four questions today and give you about four minutes to answer each one. So if you’re ready, let’s jump right in. Well, let’s start by having you tell us about yourself and your organization.

Geeta Nayyar: Sure. Well, my background again is as a rheumatologist, then an internee maybe what we call it, primary care doctor in today’s world, but I really spent my career in health technology. Used to be the CMIO for AT & T. I’m currently the chief healthcare and innovation officer for Femwell group health. We are essentially an MSO, one of the large MSOs here in the state of Florida, about 500 physicians that we serve, and we provide products and services, too, and it’s been a really amazing blend of health technology, typical MSO services but continues to be my sweet spot of giving a physician view to both business, technology and the clinical world. It’s been a fantastic journey.

Dr. Dave Levin: Yeah, that term MSO, I’m of course with it but take a minute and elaborate more on exactly what that is. Some of our listeners may not be familiar.

Geeta Nayyar: Sure. So, for Management Services Organization, and if you think of a physician’s office is having a front end, which is where the patients are seeing, which is where the waiting room is, where doctors doing the doctoring, the MSO side would be behind that. So, if you think of the backend of the physician’s office where you have to do the billing, the collections, the marketing, the EMR, all of this stuff that we as doctors hate to do, that is not the clinical stuff, that’s what an MSO to this it provides and very similar to ours. That’s what we do.

Dr. Dave Levin: That’s really interesting. How did you decide to get involved in this kind of work?

Geeta Nayyar: Sure. Well, what other things that really drew me to Femwell, is that it’s a physician owned company, so, I love the idea of working for a physician owned company that represented about 500 physicians in the state of Florida and it just felt so good to be able to help physicians do what they want to do and actually be able to talk to other physician executives and not just business people, or attorneys, or compliance folks. So, it feels really nice worker at physician organization as a physician myself.

Dr. Dave Levin: Well, this is a topic that interests me too. I remember for my early days in training, going to Dr. Power’s office. She was the family doctor, let my interest in family medicine and primary care, and she was a solo practitioner and the small business woman. It was very obvious to me from the beginning that she was both caring for her patients and caring for this business, and it took an enormous amount of time and dedication. The promise of MSOs, I think is intriguing, as you said letting docs who want to focus on clinical care and allowing others to handle the business operations. Of course, in practice it often turns out to be more challenging than it looks on paper.

Geeta Nayyar: Absolutely. You hear that, that’s right. We’re basically in health and power 500 small businesses and you and I both know, right? That the hard part isn’t diagnosing part. It takes us less than a minute to come up with a diagnosis. lupus, diabetes, hypertension. The hard part is all that other jazz that it’s only with out there and it’s the best way, and it’s really fit.

Dr. Dave Levin: Tell us what’s the most important or interesting thing that you’re working on right now?

Geeta Nayyar: Sure. So, many things. Right, but I would have to say that, us, like so many organizations are trying to figure out how you go from pay for service to fee for value and we really think our patient engagement strategy is going to help us lead that drumbeat in both models. So, the patient engagement work that we’re doing is phenomenal and I think it really touches all the different areas of population health management, telemedicine to just basic access for patients and all of the consumer centric struggles that so many offices face threats.

Dr. Dave Levin: How’s that going so far?

Geeta Nayyar: It’s going pretty amazing. It’s a really simplistic concept but essentially, we went through a vendor selection process, a pretty rigorous one. We went to class, looked over class reports. It’s one of the leaders in the space and essentially, we are really just texting our patients. We text our patients, “Hey, you’re about to turn 40, here’s some information on mammograms. We really think you ought to come in to see the Doctor Nayyar and have a discussion to things like, Hey, we just noticed you missed your appointment,” and annual wellness visits are a big part of how we prevent the flu, how we prevent diabetes. These are really simple concept, but we are getting so much out of just creating this tether between the patient and the physician, and it’s not to via portal, it’s actually not via portal, it via simple text but it’s a very smart rules engine and it’s being delivered in a way that is visible to the physicians so they don’t have to do anything, and to the patient, like all of us were very used to getting a text from our friends and family, our veterinarian, our dentists salon, but we’ve never really gotten a text from our doctor. So, it’s like, “Huh, that is so cool.”

Dr. Dave Levin: You had just picked one of my questions which was provider acceptance of this, and of course it’s, I think it’s well recognized. Our clinicians are already overburdened and super busy and folks like me implemented EMR is that made their lives even more miserable, and so when we start to talk to them about, “Hey, you can text your patients,” or “How bout some email.” Their initial reaction is often, I can’t even handle what’s coming at, we might now. How does this work? It sounds like you guys have designed a system that, and it shields them from that except when they really need to be involved.

Geeta Nayyar: Exactly. I always say that the best health technology is the one that are invisible, right. I love the word invisible, because we don’t want to mess with the work-flow. We don’t want anyone, least of all the doctors and the MAs and the staff to have just think too much and that’s really the beauty of this, is that the thinking is done by the technology and there is no work flow interruption. It is really a customer facing solutions that outreaches to the patient. This is a product by health grade is our partner and they were bought by all scripts, but essentially it will text one of our patients that, let’s say they have, what we call a gap in care, but they haven’t come in for their physical exam. They only come in for their flu shot. They’ll get a text, “Hey, this is Dr. Nayyar, just reminding you that we missed you at your annual wellness visit. Click here to make an appointment.” Really simple things like this, and it’s going a long way because they’re not used to that, right? So, first of all, they’re going to answer it because it’s from their doc, and secondly, it’s easy. They’re not getting a voicemail, they’re not having to call during office hours, and for our physicians, it’s no different than any other appointments, that just happens to be on their schedule. The schedule is well, and you’ve got three bonuses today. That’s fantastic from an ROI standpoint, right? How that appointment with me, what the outreach was, it’s really not important to the physician. So, when I say it’s invisible, that’s what really is sold us on this technology and we really went about this, like everyone else. We went out into the market thing, we need to pop health vendor. We need a pop health management solution, and what we realize is all the pop health management vendors out there were going to give us a report, and we were like, “Okay, what are we going to do with this report? We’re going to turn around and give it to the office managers that you got to call, 300 diabetics that miss their A1C or that are way out of range, that is a workflow challenge, and so what we liked about this solution is it took it a step further to say if they were going to do the pop-health stratification, but then we’re going to take care of the gap. We’re going to actually outreach to the patient, text them, call them and look, you have outliers that don’t respond but those are the ones that are in the office and their staff can focus on from a high touch perspective, but we’ve been able to find a solution for the majority of the patients pretty well.

Dr. Dave Levin: Let me ask you two questions about it specifically. I presume, knowing you, that you’re also looking at those outcomes, and so what you’ve created as a system of actionable information as you say. I got this list but what the heck do I do with it? I presume that you’re also looking at, well did it actually change things in the world real world. Are patients happier? Do they come in more those indicators or mixed or positive in this case?

Geeta Nayyar: Absolutely no. All of this is data driven. Data is the name of the game for sure. We even have some offices that told us we have a full proof system in our office, our staff calls until we do the chart reviews and then we call– We don’t want this technology. We know you’re a tech nerd, we don’t need it. First thing we did was pull their data. I said, “Do you know that you have 500 gaps in care just over the next six months. So whatever system you’re using., it has some flaws.” Or it’s about with number one or even leading the conversation with my docs to say, “Did you know that of your patient population, most of them, come back every two years for a visit, not every year?” Or that, “You’re way off when it comes to your mammograms or you’re way off when it comes to clue shots.” So, it’s a data driven conversation and definitely we’re absolutely looking at the delta. We’re really pleased at the results and we feel really good about it cause it’s again something so simple that I think a lot of folks are missing to train on frankly,

Dr. Dave Levin: Right. I would just add, that system might have been working well for that office, but it wasn’t consulting. It was very patient centric. You mentioned earlier that you are dealing with that ongoing transition from the old world fifa service model, pay me to do stuff, to the value-based model which is far more related to outcome and not just activity. The last time I looked at any given market, somewhere between 10 and 20% of reimbursement coming from value-based care, the lion’s share is still coming from traditional fee for service. I don’t know if those numbers are up to date, but I’m sure it’s at least somewhere in that neighborhood. What has always fascinated me about this question is I’ve always felt like a lot of these activities can work in either model, and I love the way you’ve referred to this as looking for gaps in care and closing them. This is not making work, this is not creating stuff. Finding care that patients really should have and then rendering it and my Dave’s theory and please call BS on it if you disagree is, well that actually works fine under fee for service and it works fine under value-based care. You just have to be thoughtful about which problems you’re going to attack and how. Does that make any sense to you or am I drinking my own cool aid here?

Geeta Nayyar: No, completely and a big part of why we went about this way is well is because it’s good medicine, whether we call it pay for value, pay for service, it’s good medicine, right? I’m always looking for solutions that are just good medicine help my physicians to be able to improve the quality of care and I want all my patients to make sure that they come in for their mammogram, their pap smear, their annual wellness visit, no matter which model I’m being reimbursed in, right. It’s just about, I think when you do the right thing by the patient, everything else falls into place. That’s always the guide that I use. Whatever the metric might be, whatever the reimbursement model might be, the standard of care and the practice of medicine should always be under that guise and I think that the problem we all have as docs, is that there’s just not a lot of tools that help us do that. That’s really the future of medicine. That’s really the future of modern medicine is going. All of these incentives are meant to just make sure we stay focused on an eye towards what is the right thing to do for our patients.

Dr. Dave Levin: I think that’s right and then finding more efficient ways do things than we did in the past and again I’m just huge fan of this idea of actionable information. It does me no good to have information if I can’t actually do something with it to make the world a better place. I love this very practical approach that you’re taking. I want to ask you the next question and at this point I off usually remind my guest, that this is a family show so please keep it PG 13, but we want to hear your current favorite rants or pet peeve.

Geeta Nayyar: I want to ask you save it. Probably my biggest pet peeve is just doing with social and data basis in the industry that always lead with this is what we’ve always done. This is what we did five years ago, this is what we did 10 years ago. This is what we do with the last organization I was in when we were faced with this problem. I agree with looking to historical data and survey data and things that have guided us in the past. Well, where we are in medicine today is very different. It’s very different, and I think to really make an impact on the industry today or even just from an innovation standpoint, I know I want to work with people who can think outside of the box that will keep in mind, what history is, but are also looking to the future for new solutions and new ways to do things. I think that’s the only way to be successful healthcare and really make an impact, and so that is my biggest pet peeves is. Whenever anyone leaves with, “This is how we’ve done it,” or “This is how we did,” it just makes me cringe a little because I already know that whatever they’re going to say after that is not going to be the solution.

Dr. Dave Levin: After you count to 10 internally, what do you say or do in those situations that you found to be constructive?

Geeta Nayyar: Well, I always say that’s not where we are today. I totally recognize, validate where we’ve been and where you come from, but where we are today is X or where we need to be tomorrow with Y, and the truth is we don’t know, and I never pretend to have the answers, I just know that theis environment is different and the goal is different. Clearly the solution has to be done.

Dr. Dave Levin: Yeah, this has been a theme for through this early podcast series. This issue of we need to innovate and there are great ideas from many other fields outside of health care. We want those ideas to come in. At the same time, there’s reasons why we do some things we do in healthcare the way that we do that there’s useful history there too, and so there’s this mashup that’s going to need to occur where new ideas come in, they’re informed by history and experience, but they don’t drown in that, and it’s just, the reason I bring this up is most everybody I’ve talked to in this podcast series, this question has raised its head in one form or another.

Geeta Nayyar: Good. I’m not alone.

Dr. Dave Levin: No, no you’re not. No, you’re not. I think it requires all of us to come at it with an open mind and patients. All of us. Then folks come in and new as well, because it doesn’t really help if they come in and their attitude is what you people have been in health care, you all must be stupid or lazy. You can’t figure this out. It’s not that hard

Geeta Nayyar: For sure.

Dr. Dave Levin: At the same time, when we stand up and go, well, you don’t understand healthcare is different. Well, that kind tends to shut things down as well.

Geeta Nayyar: Totally I agree. Totally I agree.

Dr. Dave Levin: That’s a pretty good pet peeve. For our last question today, what I’d like you to do is share with us your most sage advice.

Geeta Nayyar: I would say, and I say this a little bit as a mom as a doctor. There’s this is one quote that I love, and I actually don’t even know who is the person that came up with it, but the quote that always come to mind for me is, “A good man or woman who does nothing is evil enough.” Right, it’s not enough to just be a good person and some of us just be a good doctor. I truly feel that it’s important to push yourself beyond yourself, push yourself beyond your individual profession, and really contribute. Contribute outside of yourself to your community, to your society, to your world, because just being a good person, it’s fantastic, but if you’re not aware of what’s going on around you, and the fact that you might be able to impact it, I think that’s a sad thing and I think that’s a missed opportunity, and I feel like I see it every day, either personally or professionally, and I think it’s just folks got a get up and participate. Get up and participate, whatever that might be. Then again, when it comes to my daughter, don’t just be the observer. Get out there and do something. Even if you can’t do it perfect, you’ll learn and you’ll contribute and you’ll do your best. You’ll do your best.

Dr. Dave Levin: I certainly share that belief and I’m always frustrated when people want to just basically sit on the sidelines and complain about things or be helpless, it’s far more empowering beginning the game and absolutely you’re going to make mistakes and you’d probably make a few things worse rather than better. That’s part of the process as well. I think the other thing that I find consistently is people that I meet that are the most interesting, the most affective and who seem happy have a balance in their life as well. Yeah, there’s meaning in their work, but they’re not all about their profession, and so I loved reading about your other activities and your involvement with your daughter. I think we all have something could contribute in that way. It makes us a better person too.

Geeta Nayyar: Absolutely. That’s why we pick health care, right, before we pick medicine.

Dr. Dave Levin: Well, I think that’s right, and I think part of fixing health care is creating better balance in the lives of our clinicians and others that work in health care. You didn’t reference this, but it’s pretty clear burnout as a serious issue getting worse, and I think part of this is, clearly internal, the mechanics of health care and where we are right now, but I also think some of it is cultural and historically we’ve not been good about balance in our lives, and setting that example for young clinicians, doctors, nurses or or what have you. Forgive me. I feel like I’m giving a lecture.


Geeta Nayyar: Not at all.

Dr. Dave Levin: I’ve been so fortunate in my life to have good mentors and role models around. I see others that I think suffer because they haven’t had that. Again, I would ask you to either validate that or correct me.

Geeta Nayyar: Completely. Completely listen. One of the things that every year, at the beginning of my daughter’s school year, they ask all the parents what they want to volunteer for, and they have Halloween trade, and they’ve got the bake sales, and they’ve got just any number of awesome activities for folks to participate in. I just go to the teachers every year and I said, “Can I teach the class [Diane]?” I do a great job of teaching the kids, heart, lung sounds, how to take their pulse, and again, also just so the girls in the class can also see a female physicians teaching them a mama up there, doing something a little bit outside of the box, and it’s really simple, and to be honest with you, it’s so easy, and Fun for me. I much rather volunteer in activity that I’m really good at, and I do every day than try to carve a pumpkin, I’m not very good at that Dave.

[laughter]. Let’s say for me to be doing this. I don’t think you have to go so far outside of yourself is what I need to say, but I think being thoughtful about what would be the most impactful way to spend your time and most impactful thing to do, especially for our kids. Just something we should all think about, and I think time is precious. We live in a world where everything is instant, everything is quick. My time is very precious. Your time is very precious. So, I’d like to make the most out of my time and I think that taking a minute to stop and think about what that is, is just as important as actually doing it.

Dr. Dave Levin: I think that’s so true. In my case, it’s attempting to play video games with my two boys. I’m horrible, but they don’t care. They just want to be doing something together, and that’s what they care about. I could not agree more. Well, this has been really terrific Geeta. I appreciate your time today, and your observations, and your sage advice. Let me give you the last word before we wrap up today.

Geeta Nayyar: Thanks so much, David. I really appreciate you wanting to and get behind the covers folks like me just to really have a conversation authentically about what’s going on in the industry and where someone like I come from or other folks might come from. I think it makes all the problems in health care much more real and we’re not just talking in the buzzwords, which is always really helpful. I appreciate having a real conversation with you.

Dr. Dave Levin: We appreciate your authenticity as well. I knew you’d be terrific. I admire your leadership. I admire your social media presence as a leader. What I heard today is what I always hear from great leaders, they’re focused on growing their organization, but they’re also focused on growing the people. It’s a tall order, but it’s the right way to do things, so thank you for that example.

Geeta Nayyar: Thank you Dave. Thanks so much. Great to talk with you.

Dr. Dave Levin: We’ve been talking with Dr. Geeta Nayyar, MD, MBA, chief healthcare and innovation officer for Femwell Group Health. Geeta, thanks again for joining us. You’ve been listening to four by four health sponsored by Sansoro Health. Sansoro Health, integration at the speed of innovation. Check them out at www.sansorolhealth.com. I hope you’ll join us next time for another Four by Four discussion with healthcare innovators. Until then, I’m your host, Dr. Dave Levin. Thanks for listening.