Tuesday, January 7, 2020
The Spark Behind the Summit
In this intimate interview, Dr. Zeev Kain MD. MBA. MA (hon) speaks about his motivations in medicine, his three-in-one career, and how he hopes the Orthopedic Value-Based Care conference will revolutionize the delivery of medicine, one team at a time.
Why did you decide to practice medicine?
It wasn’t really a question for me. I am a child of Holocaust survivors from Europe and I was always told that it was doctors who really helped other people in situations like that. I was drilled from a very young age that this is what you need to do to help people.
What parts of your job have you found especially rewarding?
Ideation. And connecting people. I just love bringing people together as a team and I really enjoy the ideation part around doing so.
Tell us about your career.
I like to think about it as having three careers. The first one was my clinical career as an anesthesiologist which led me to be Anesthesiologist Chief of Yale-New Haven Children’s Hospital. Those 20 years were really devoted to perioperative care and research funded by the NIH.
The second part of my career focused on administration. I was the chair of a large clinical department. I ran the operating rooms and anesthesia department. I was the chief medical officer. And I was the Dean of Clinical Operations in a large healthcare system.
And then my third career is my innovation career, where I’m amalgamating and synthesizing everything I’ve learned and am engaged in fixing entire healthcare systems rather than individual hospitals. At this point in my career, I see patients only a few times a month as an anesthesiologist. I am running the Center on Stress & Health, a large centre for research funded by The National Institute for Health. It has a team of 30 people devoted to preparing and optimizing children and their parents for the process of surgery and conducting much of its research in the mHealth space. I am also the Director of System Redesign and Value Based Care at the UCI Health Policy Research Institute. And then I’m also focused on the American College of Perioperative Medicine, which is a non-profit, inclusive organization dedicated to providing an educational and collaborative experience for all healthcare stakeholders. Our conferences and boot camps are aimed at challenging the current perioperative structure and facilitating the shift towards evidence-based, standardized, patient-centered care. This organization produces the Orthopedic Value-Based Conferences, amongst other things.
You can talk about the conceptual framework of value-based care but the question is: How do you do it practically? That is what my conference is striving for.
How would you like to see medicine evolve in the future?
I would love healthcare to focus on keeping people healthy rather than fixing them once they are broken down. It is much more cost-effective to treat a machine while it’s working than wait until the machine breaks and then bring out a bunch of mechanics to fix the machine and get it going again. It would be nice if the financial picture would change to reward maintaining healthy people rather than reward fixing broken people.
Secondly, I really would have liked the system to work together and break the silos that exist right now. Kaiser, for example, is a perfect example of a good ecosystem. It is essentially three separate organizations: it’s a hospital, it’s a physician group, and it’s an insurance company, all working together with a common bottom line. We also can’t forget the employers and the medical device industry. They are our partners and must be included as a part of the redesign we want to introduce.
It would be nice if the financial picture would change to reward maintaining healthy people rather than reward fixing broken people.
If, on the other hand, you take any other hospital – you have the hospital’s bottom line, you have the physicians’ bottom line, and then you have the insurance group’s bottom line. Not unfrequently, it’s a zero-sum game. You have a confrontation between these three entities and competition on dollars. There is a lack of alignment of incentives between these major stakeholders. The key is to build organizations that have a common bottom line, a common incentive plan – and then you can have the personalities within them work together.
Now, that is the dream. Until we have that dream, I am focusing on a grassroots level to inspire and facilitate change.
If there is a burning platform, then people can change and be very flexible. That is why orthopedics is the low-hanging fruit because there is a burning platform, which is a financial one.
What is the biggest obstacle to making that happen?
The number one obstacle is the lack of a burning platform. If people are not forced to change, nobody wants to change. If there is a burning platform, then people can change and be very flexible.
That is why orthopedics is the low-hanging fruit because there is a burning platform, which is a financial one. So everybody says, “We do need to do better. Here are 15 ways that we can do things better.”
How do you think your conference can contribute to this evolution?
The Orthopedic Value-Based Care Conference is teaching people how to work as a group and implement models that advocate value rather than volume. We are bringing all the stakeholders into the same place at the same time to listen to the same thing, which is the beginning of the process. Then, we are teaching the nuts and bolts of how to actually do this.
You can talk about the conceptual framework of value-based care but the question is: How do you do it practically? That is what my conference is striving for. We have a mixture of people from academia and private practice because we know that what is being done at Hopkins, for example, may or may not be relevant to a large community hospital. We really need to appreciate even the silos between academia, private practice, and integrated systems and break those as well.
We are bringing all the stakeholders into the same place at the same time to listen to the same thing, which is the beginning of the process.
Lastly, what’s new at the 2020 OVBC?
Because our orthopedic conferences were so successful, we have decided to add two more mini conferences.
On Friday we have one on enhanced recovery surgery and the surgical home, which is where I started. Then on Saturday, we have an advanced value-based healthcare conference focused on bariatrics, women’s health, and cardiology.
All three conferences happen at the same beautiful Fashion Island Hotel in Newport Beach. So we are going to break the silos even further because now, during break times, you’re going to have cardiologists talking to perioperative people. There are opportunities for people to really interact with each other in a meaningful way – a key to breaking silos!