Fall 2019 | Volume 8 | Number 4
In Every Issue
Feature Articles
In Upcoming Issues
The Day After....Cancer Survivorship

Tooth Decay: From Condition of Humanity to Consignment to Medical History? Part 2
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Editor's Letter
Professor John McCarthy of Stanford University is credited with founding the field of artificial intelligence (AI). AI is one of the buzzwords of today, but I would liken it to a time when the definition of disease management depended upon to whom you were speaking. 

John McCarthy described AI as “…. the science and engineering of making intelligent machines, especially intelligent computer programs. It is related to the similar task of using computers to understand human intelligence, but AI does not have to confine itself to methods that are biologically observable.” 

But when asked is there a solid definition, his response was “The problem is that we cannot yet characterize in general what kinds of computational procedures we want to call intelligent.”

Following this fall's Wharton Health Care Conference, “A PotpourrAI of Applications," expect to see more content on AI in future issues as well as in the WHMCAA LinkedIn group.

Z. Colette Edwards, WG'84, MD'85
Managing Editor

Contact Colette at: colette@accessinsightmd.com

To learn more about Colette, click here .
In Every Issue
The President's Desk
Contributor: Maria Whitman, WG’05

This summer I found myself reflecting often on the experience of healthcare. I guess it started while I prepared a keynote talk on driving better customer experience in oncology for one of my biopharma clients. I wanted my audience to feel something… to make real the needs and expectations of the people on the other end of the work they do. It led me to reflect a bit more broadly on how the very expectations of customer experience have evolved so greatly today in every aspect of our lives.  Read more .
The Philosopher’s Corner
Contributor: Mark Whitcher, CEBS, WG’93   

This eclectic standing column features insightful musings, words of wisdom, life lessons, and stepping stones to business success. This month's philosopher is Mark Whitcher, CEBS, WG’93 . Chairman and CEO of KTP Advisors. His areas of expertise include: Medicare plans of all types, healthcare exchanges, Employer Group Waiver Plans, contract negotiations, Health Reimbursement Arrangements, Voluntary Employees’ Beneficiary Association (VEBA) Trusts, and Section 115 OPEB trusts for municipalities. Read more .

We'd love to hear from you and invite you to click here to participate in future editions. 
Affidavit: Healthcare and the Law - DOJ Updates Guidance on Corporate Compliance Programs    

Like all corporate entities, healthcare entities rely on rigorous compliance programs to ensure they are operating within the bounds of a complex regulatory environment. On April 30, 2019, the United States Department of Justice (DOJ) Criminal Division released updated guidance on corporate compliance programs. The new guidance document, which updates a previous version issued by the Division’s Fraud Section in 2017, is designed to assist prosecutors in evaluating whether a corporate entity’s compliance program was effective at the time criminal conduct occurred.  Read more .
Downloading Success : Healthcare Executives Look Beyond Borders  
Contributors:   Inga Walter and Nathaniel Hook 

Healthcare has historically been a national affair and executive vacancies, whether on the clinical or administrative side, tend to be filled with domestic talent. Not only do regulations and accreditations change from country to country, but language and culture also play a big role.

There are, however, increasing global career opportunities for healthcare executives. A U.S. health system creating an alliance overseas has many considerations to take into account when it comes to sourcing talent. Within the region or country they will be able to find talent that understands the local market, language and culture, but at the same time, overseas (U.S.) expertise on the clinical and operational side is necessary, as it is the very reason these partnerships were established in the first place.

What does this mean for healthcare executives looking for career opportunities? More than ever before, there are global career opportunities in healthcare. Read more .
To Your Health: The Dark Side of Space and/or Sitting 
Contributor:   Rich Butler, MS, USPTA

In honor of the 50 th anniversary of the moon landing, I thought it would be appropriate to discuss some of the lessons learned from the space race and compare them to 21 st century life on Earth. You know, how does floating in the space station compare to chilling on the couch with your tablet? 

Dr. William Evans studied one of the worst things that a human can be exposed to, inactivity. He compared astronauts to subjects who were mandated to stay in bed for weeks and found stark similarities. Not surprisingly, humans do very poorly when you remove gravity. And they also do very poorly when they live a largely sedentary lifestyle. Read more .
Mind the Gap: Learning on the Way to Wellville
Contributors:   Rick Brush and Jeff Doemland

Wellville is a national non-profit project to improve equitable well-being in five U.S. communities over 10 years, while sharing what we learn as a path toward national change. Founded by angel investor Esther Dyson , Wellville supports its communities like a business accelerator helps start-ups: We provide dedicated advisors who work with multi-sector teams in each Wellville community; we ask lots of questions; and together we learn through the thinking and actions of hundreds of local people and institutions collaborating with thousands of community members to make life better in the five places they call home. Read more .
Mind the Gap: Addressing Social Determinants of Health: Where to Begin?

With all the buzz about social determinants of health (SDOH) across industry headlines, healthcare leaders are no doubt acutely aware of the need to address the non-clinical needs of the patients they serve. SDOH has demonstrated an immense impact on physical and mental health, with factors ranging from food insecurity to companionship for shut-in patients to lack of affordable housing and green space in urban areas. Therefore, appropriately addressing SDOH needs is increasingly cited as a necessary component of successful population health management programs. Yet, oftentimes the steps to move forward can feel complex. 

So where to begin? If a comprehensive enterprise plan is daunting, we suggest starting with a framework we call “Screen and Refer.” We offer six steps every organization can take to begin building such a program. Read more .
Feature Articles
The Road to Redemption: Construction Ahead

The Patient Protection and Affordable Care Act (ACA) is perhaps the most important and powerful piece of population healthcare legislation ever because it lends credibility and confers legal status to a concept that those of us in the field have understood and preached for decades. True, the ACA is not the panacea that some had hoped, but it is a major step in the right direction with 20 million more citizens now having access to health insurance and primary care services. 

Constant assaults on the ACA have chipped away at its broad-ranging mandates, but there is abundant evidence that one core concept will survive and thrive - value-based payment (VBP). Payers already know the road to redemption (better health outcomes and lower costs) is paved with VBP. 

Despite our tendency to politicize the issues, the system itself remains the overwhelming problem. 

Looking down the road, we can expect some construction delays, but I’m optimistic that VBP will eventually lead to better health for the system and the population. Read more .
Open Wide: Tooth Decay - From Condition of Humanity to Consignment to Medical History? Part 1

The “Open Wide” column went on hiatus about two years ago because I felt that all that could be said about the dental care industry in this country had been said. The interregnum between the last “Open Wide” entry and the present one has not been an idle, however. My observations and comments on the dental care industry have resonated with a few others in the profession, similarly disaffected by the “drill, fill, and bill” doctrine, to the point where I was asked to write the policy chapter for an upcoming book on a wholly new approach – from basic science principles to dental education and training to new dental care delivery models – to addressing the disease of tooth decay. [The book, to be published in October, is titled SMART Oral Health [“SMART” being an acronym for a rather cumbersome term “silver-modified atraumatic restorative technique,” the explanation of which is best kept for another time.] 
Matters stand differently now – tooth decay and its sequelae (costly treatments like crowns, “root canals,” implants; unnecessary and risky sedation or anesthesia; and serious infection and death resulting from that) can indeed move into the realm of being truly prevented, with the control, reduction, and conceivably even the eradication of tooth decay within a population being possible. Read more .
It Takes a Village
Why partnerships are at the root of success in digital healthcare
Contributor: Anish Sebastian

Look behind any successful person, scratch the surface of any profitable venture, and you’ll find the same thing: a network, a community, a group of collaborators that are at the heart of the successes. It’s the founding premise of Darwin’s evolutionary theory: over history, “those who learned to collaborate and improvise most effectively have prevailed.” The healthcare space has been slow to learn that lesson. 

Nowhere is the tension more obvious than in the struggle to integrate technology and healthcare. Healthcare is the established player and tech is — well, the disrupter. And the establishment does not respond well to disruption.  Read more .
An Interview with Rachel Mertensmeyer
Contributor: Beverly Bradway, WG ’91  

Hear from Rachel Mertensmeyer, CEO and Co-Founder of RexPay, who started her company while living in New York City and working at Unilever in Brand Management. She suffered an injury that left her with 38 medical bills and $10,000 of debt across 11 providers. “It was a frightening and difficult time made worse by an ongoing stream of bills, service statements, insurance letters, and duplicate notices. It was hard making sense of it all — which ones to pay, what to pay, and what insurance covered. Furthermore, I wound up needing $10,000 to cover my share and financed it with credit cards - at 26% interest!  

Getting through this was a real challenge. I was spending hours on the phone, constructing elaborate Excel spreadsheets for tracking purposes, and managing stacks of information with priorities that were unclear. This is what led to my ‘aha moment.’ I had to find a way to help patients centralize medical bills, offer guidance on process and payments, and eliminate the unnecessary complications.”  Read more .
Strategic Alignment for New Initiatives
Contributor: Carey Gallagher 

While health systems have long sought to expand to gain market share, today they often want to expand to stretch across the continuum of care or integrate more tightly across a handful of aligned offerings. This can mean that when leaders launch new initiatives, they are often not entirely new — it may be a plan for closer collaboration from a diagnostic stage to recovery from surgical procedures, or horizontally across their practice plan. The new leadership roles often overlap with existing structures other parts of the organization, and the nascent strategies may require minimal external hires. More often than not, new initiatives stumble because they lack a vivid picture of their purpose, and so create confusion on the ground to execute on the vision.  Read more .
Disclaimer : The opinions expressed within are those of the authors and editors of the articles and do not necessarily reflect the views, opinions, positions or strategies of the Wharton School and/or the University of Pennsylvania, and/or their respective organizations. Publication in this e-magazine should not be considered an endorsement. The Wharton Healthcare Quarterly and WHCMAA make no representations as to accuracy, completeness, currentness, suitability, or validity of any information in this e-magazine and will not be liable for any errors, omissions, or delays in this information or any losses, injuries, or damages arising from its display or use.