5 Things We Must Do To Improve the US Healthcare System: With Limor Weinstein & Christopher K. Lee of TEKEZE Solutions

“Guided choice is about meeting patients where they are; listening and understanding their goals, values, and preferences; explaining in layman’s terms their diagnoses, treatment options, risks, and benefits; and helping them make care decisions that align with their priorities. Through guided choice, we can restore the human component in medicine.”

As a part of my interview series with leaders in healthcare, I had the pleasure to interview Christopher K. Lee, the Director of Marketing at TEKEZE Solutions, Inc., a technology startup spun out from a large community health center. In addition, he teaches healthcare administration at local colleges and serves as a mentor through the San Diego Organization of Healthcare Leaders. He holds a B.A. in Psychology from UC Irvine and a Master of Public Health from San Diego State University. Chris is a Certified Professional in Healthcare Quality (CPHQ) and a Lean Six Sigma Green Belt. He has been quoted in outlets such as HuffPost, U.S. News & World Report, Medscape, and Becker’s Hospital Review.

Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?

I’d say there were two defining moments. I had studied psychology and planned to become a therapist. But my first job after college was at a medical practice brokerage doing business valuations. It opened my eyes to the non-clinical side of healthcare and motivated me to pursue a degree in health administration.

In grad school, I set my sights on becoming a hospital administrator. But when the Affordable Care Act (ACA) passed, I found it difficult to land a hospital position. Large health systems, which are typically receptive to grooming talent, were “belt-tightening,” i.e., getting rid of administrative fat. Small hospitals wanted people with 5–10 years of experience to hit the ground running. So I looked beyond hospitals and took a position at a health IT startup. The company experienced massive growth and a successful exit a few years later. Seeing the impact we were able to make inspires me to stay in the innovation space.

Can you share the most interesting story that happened to you since you began leading your company?

I don’t have one particular story. But I’ve had many interesting conversations with executives from the largest medical groups, integrated delivery systems, and federally qualified health centers (FQHCs). I’ve met with Ivy League medical school faculties. Their organizations are the gold standard in their categories. From the outside, one might think that they have it all together. But through these discussions, I’ve been amazed at how much help healthcare organizations need from a technological standpoint — even large, well-known industry leaders. So I feel affirmed that we’re in the right place to make a difference.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

One mistake I made early on was talking shop all the time in professional settings. I drew a line between my work and my personal life, my coworkers and my friends. The two did not mix. Over time, however, I noticed that those who advanced faster in their careers — and indeed, appeared happier in general — were people who built relationships with their colleagues outside the workplace. They did not compartmentalize their life the way I did. I was seen as a valuable connection and coworker, but I was no fun to be around.

The lesson I learned was this: We are all human. We all have passions and interests; families and personal lives; hopes, dreams, and insecurities. While I need not be buddies with everyone, connecting over shared experiences and salient identities fosters better working relationships. There is a time and place for talking business. But often even at a networking event, it’s not the dialogue on market trends or policy changes that leads to further collaboration. It’s finding common interests and relating to each other.

What do you think makes your company stand out? Can you share a story?

TEKEZE Solutions, Inc. is a technology spinout from one of the largest community health centers in the U.S. We are bringing to market a suite of software built to run the clinics. Unlike other vendors’ products, our solutions were developed in-house in tandem with our medical leadership and clinical quality team.

When I first started, I toured a dozen locations to hear what users had to say about their experience. I spoke with doctors, nurses, physical therapists, health educators, front desk staff, billers and coders, and more. A medical director commented: “Physicians want two things from electronic health records: save me time, and help me avoid mistakes.” He went on to describe how our system fits into his workflow and improves his practice. This aligned with what our CEO says: We develop our products with a relentless focus on user-friendliness and optimization. I soon saw this philosophy woven through all our solutions.

What advice would you give to other healthcare leaders to help their team to thrive?

Organizations large and small alike are hindered by poor communication. Here are two thoughts to reduce friction and, as they say in strategy, “get everyone in your boat rowing in the same direction.”

1. Take time to listen. Show that you care. Create a safe environment to express ideas, even disagreements. A major driver of employee burnout is feeling unheard and unrepresented.

2. Communicate early and often. Set clear expectations of both the whys (objectives) and hows (deliverables). Offer regular feedback and guidance, so there are no surprises down the line.

Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?

1. Most developed countries spend more on social services and less on medical care. In the U.S., the ratio is reversed. In other words, we spend money on fixing, rather than preventing, health problems. That’s why the conversation has shifted to addressing “social determinants of health.”

2. U.S. medical care is more expensive — from doctor visits to hospital stays to prescription drugs. Therefore, many people postpone getting necessary care, so their health declines over time.

3. We have a fragmented system of employer-sponsored insurance. Large swaths of the workforce (e.g., self-employed) don’t have adequate coverage. This problem is growing in the gig economy. Even insured employees now face onerous deductibles. As discussed, cost is a barrier to care.

4. Our healthcare delivery system is also siloed. There’s a divide between general and behavioral health; between medicine and dentistry; between ambulatory and inpatient and post-acute care. There’s little communication and data-sharing among providers to enable patient-centered care.

You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

1. Promote “guided choice” in medicine. In the past, patients followed the mantra “doctor knows best.” They unquestioningly accepted every recommendation, though some may have been inappropriate for them. Many elderly patients still hold this mentality.

Today we hear about “healthcare consumers” who, armed with the internet, could shop around and make their own care decisions. Moreover, doctors are rated on patient satisfaction measures. In theory, this reduces medical paternalism and forces patients to be accountable for their health. In practice, however, it has also led to inappropriate self-diagnoses and requests (e.g., patients with viral infections demanding antibiotics).

Neither extreme is ideal.

Guided choice is about meeting patients where they are; listening and understanding their goals, values, and preferences; explaining in layman’s terms their diagnoses, treatment options, risks, and benefits; and helping them make care decisions that align with their priorities. Through guided choice, we can restore the human component in medicine.

2. Regulate consolidation more closely. Over the past decade, providers and insurers have been in an arms race to grow larger. We see hospitals merging to negotiate higher rates from insurers. We see health plans merging, so that they can pay hospital systems less. Physician groups, likewise, have acquired other practices or been acquired themselves. We’ve witnessed an uptick in vertical integration too, as large players seek to control the provider, payer, and supplier side.

Consolidation in healthcare will continue, even accelerate. But is it good for patients and society? We hear rhetoric of synergies and economies of scale. Yet how often is this corporate-speak for layoffs and higher prices? How often are cost savings passed onto patients and consumers? Does it improve quality and lower patient financial burden? Study after study suggests that it does not. Martin Gaynor, PhD, healthcare economist and professor at Carnegie Mellon University, testified before Congress last year on the negative impact of consolidation. He recommends ending policies that “hamper new competitors” and “unintentionally incentivize consolidation.”

3. Realign incentives in the interest of patients. There’s a lot of finger-pointing these days over who’s responsible for our rising healthcare costs. Hospitals and insurers blame one another for reaping excessive profits. Drug manufacturers and pharmacy benefit managers (PBMs) accuse each other of deceptive practices. Yet none of them want to rock the boat. Their lobbyists defend the status quo, on which their businesses are built. In the end, patients are the ones who lose.

Dismantling the perverse incentives starts with understanding the existing system. I appreciate the work of experts who help cut through the noise. Two, in particular, come to mind: ProPublica reporter Marshall Allen and Drug Channels consultant Dr. Adam Fein. For example, read Allen’s articles on why your health insurer and benefits broker may not be on your side. Likewise, Dr. Fein offers insight into the unintended consequences of the 340B program and drug rebates.

4. Eliminate surprise medical bills. Every few weeks we see a shocking medical bill in the news. A patient returns home from the hospital, only to receive an exorbitant bill he or she didn’t expect.

For the uninitiated, here’s how surprise medical bills occur:

Managed care plans contract with medical groups and hospitals to care for their members. Those willing to accept their negotiated rates are considered “in-network.” Patients are incented through lower co-pays to seek care from in-network providers. They may visit out-of-network providers, but they’d be responsible for higher cost-sharing. In theory, this helps rein in medical spending.

Unfortunately, it doesn’t always work as designed. Patients may go to an in-network hospital — that is, they did everything correctly — yet the emergency physician or the anesthesiologist may be out-of-network. These doctors are not contracted with the patient’s insurer. So they “balance bill” the patient directly for the remainder of their rack rates.

Merrill Goozner, editor emeritus at Modern Healthcare, comments in an editorial: “Sometimes, complex problems have simple solutions. Why not just ban balance billing and let the hospitals, their staffing contractors and insurers sort it out? If all parties respond by raising prices and, therefore, premiums on employers, go to plan B, which is price controls.”

5. Enable patient data-sharing across organizations. Whether it’s a specialist referral from primary care, a hospital discharge to a skilled nursing facility, or simply when a patient switches doctors, the patient’s medical records should go with him or her. Unfortunately, this isn’t happening.

The problem is part technological, part cultural. I’m less concerned about the tech component. Over time, by choice or by consequence — CMS is ready to bring down the hammer on electronic health record (EHR) vendors’ information-blocking behavior — these limitations will be resolved.

I’m more concerned about the cultural element. As I mentioned, the U.S. healthcare system operates in silos. Some would even say “system” is a misnomer. We don’t have a system; we have a marketplace of independent players all vying for their slice of the pie. They believe that patient records belong to their organization. So although most are talking about interoperability and information exchange, few are willingly sharing patient data, if competitors are not doing likewise. They want to prevent patient “leakage” and maintain market share.

Ok, it’s very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

Individuals can make their priorities known through their consumption patterns. Although the impact of “consumerism” (e.g., price-shopping) has been limited, consumer preferences are driving change. For example, Modern Healthcare reports: “Low adoption of telemedicine may spur patients to migrate away from traditional providers.” Patients want convenience when possible, so “use it [telehealth] or lose them.”

Corporations can start by reviewing their insurance contracts. A company’s benefits broker may not be acting in its interests, since most brokers are compensated by the health plans. Large employers may wish to explore worksite clinics, chronic disease management programs, and direct contracting as well.

Community organizations can come together to learn from each other. As they say, a rising tide lifts all boats. They can align resources toward common goals to reduce duplicative efforts. Building trust over time paves the way for further collaboration. Data-sharing, for example, can start with a close-knit group.

Leaders have a great opportunity to transform healthcare. Legislators should cultivate deeper knowledge of the industry’s nuances, so that they could pass effective laws and avoid unintended consequences. Healthcare executives should choose to do what is right, not what is popular or profitable in the short-run.

As a mental health professional myself, I’m particularly interested in the interplay between the general healthcare system and the mental health system. Right now we have two parallel tracks mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?

I agree that there’s a divide between physical and mental health. And it gets messy when the two collide. Too often, psychiatric patients are admitted to general hospitals, where the staff aren’t trained to care for them. This puts all parties in a compromised situation — the hospital, staff, and patients alike. One solution involves partnering with a community provider who is equipped to care for behavioral health patients.

At TEKEZE, we believe in 1) delivering the right care in the right place, and 2) integrating primary care with behavioral health. Our ER Connect solution has fostered a partnership between hospital EDs and a federally qualified health center (FQHC) in San Diego, CA. The FQHC opened integrated behavioral health clinics nearby and on hospital campuses. When a psychiatric patient presents at the ED, case managers use the ER Connect platform to send a direct referral into the clinic’s practice management system. In most cases, hospital staff walk patients over to the clinic for an immediate warm handoff. The clinic then becomes the patient’s “medical home,” where they receive both primary care and behavioral health services. This has led to improved patient outcomes, while reducing unnecessary ED visits.

How would you define an “excellent healthcare provider”?

To me, an excellent healthcare provider is one who can enable guided choice. I believe two distinct skill sets are required. Most providers are proficient in one or the other. Having both is a mark of excellence.

First, excellent healthcare providers have the expertise to deliver quality outcomes. They are current on medical knowledge and clinical practices. They can make the right decisions with incomplete information.

Equally important is the human component. Excellent healthcare providers listen with empathy and build a strong connection with each patient. At the same time, they are able to work with diverse populations.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“Do what is right, not what protects your tenure.” — Michael Restuccia, SVP/CIO, Penn Medicine

At a conference last year, Mr. Restuccia exhorted the audience: “You can’t please everyone. When you’re in a position of influence, each decision you make will piss off some people. After a handful of decisions, almost everybody’s upset at you for something. But do what is right, not what protects your tenure.”

I feel this is something healthcare leaders today need to hear and be reminded of regularly.

And though he was talking about career, this call to integrity transcends our professional lives. It should take root in our personal values. We tend to think of integrity as not lying, cheating, or stealing. Or as keeping promises and following laws. But integrity requires more than knowing right from wrong; it takes courage to cut against the grain. How often have we turned a blind eye to things we believe are wrong?

Recalling the speaker’s words, we could substitute many things for “tenure.” Will you “do what is right, not what protects your [privilege, income, reputation, comfort, relationships, social status, etc.]?”

I know I try to live this out on a daily basis.

Are you working on any exciting new projects now? How do you think that will help people?

I’m particularly proud of our ER Connect solution, which we have installed in emergency departments across San Diego. When an uninsured or Medicaid patient without a primary care physician presents at the ED, hospital discharge planners use ER Connect to schedule an appointment directly into our partner clinics. It’s a win-win situation all around: The hospital improves throughput, ED beds are available for those with emergent needs, the uninsured and Medicaid patients now have a “medical home” where they get continuity of care, and the clinics receive enhanced reimbursement rates for Medicaid patients.

We are working with other hospitals and clinics to replicate this in their cities. After all, population health management starts with delivering the right care in the right place for each patient. We’re enabling that through solutions such as ER Connect.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

Here are a few resources that have inspired me in my career:

1. The American College of Healthcare Executives (ACHE) is a national professional association for healthcare leaders. I’ve been involved with the local chapters in Southern California since 2012. Beyond the educational programs, ACHE is a great resource for both networking and mentorship.

2. Modern Healthcare is a weekly magazine on healthcare business topics. It keeps busy executives abreast of current market trends and regulations to identify both opportunities and headwinds.

3. “Ex-Acute” is a book by Dr. Josh Luke detailing what’s wrong with the U.S. healthcare system. Josh is a former hospital CEO and a colleague of mine. I appreciate his passion and willingness to rock the boat. He’s not afraid to call out organizations when they put profits before patients.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

Outside of healthcare, I run a career coaching practice called PurposeRedeemed. Our mission is to “inspire a countercultural view of work that affirms the dignity of every individual and drives sustainable community impact.”

From my observation, our culture holds two views of work: 1) some people see it as their source of significance; and 2) others see it as merely a paycheck. Neither is an accurate depiction of what work is or should be. I believe that work should be meaningful, impactful, even joyful. That’s why I started PurposeRedeemed to elevate the conversation on work and identity and to inspire a better way.

How can our readers follow you on social media?

Readers can follow me on Twitter (@chrisleemph) or connect with me on LinkedIn. I also manage a Facebook group, where I share healthcare news, networking events, and job openings.

Thank you so much for these insights! This was so inspiring!

About the Author:

Originally from Israel, Limor Weinstein has been anorexic and bulimic, a “nanny spy” to the rich and famous and a Commander in the Israeli Army. Her personal recovery from an eating disorder led her to commit herself to a life of helping others, and along the way she picked up two Master’s Degrees in Psychology from Columbia University and City College as well as a Post-Graduate Certificate in Eating Disorder Treatment from the Institute for Contemporary Psychotherapy.

Upon settling in New York, Limor quickly became known as the “go to” person for families struggling with mental health issues, in part because her openness about her own mental health challenges paved the way for open exchanges. She understood the difficulties many have in finding the right treatment, as well as the stigma that remains so prevalent towards those who are struggling with mental health issues. She realized that most families are quietly struggling with a problem they’re not comfortable talking about, and that discomfort makes it much less likely that they will get the help they need for their loved ones. She discovered that being open and honest about her own mental health challenges took the fear out of the conversations. Her mission became to research and guide those families to the highest-quality treatment available. Helping others became part of her DNA, as has a commitment to supporting and assisting organizations that perform research and treatment in the mental health arena.

After years of helping families by helping connect them to the right treatment and wellness services, Limor realized that the only way to ensure that they are receiving appropriate, coordinated and evidence-based care would be to stay in control of the entire treatment process. That realization led her to create Bespoke Wellness Partners, which employs over 100 of the best clinicians and wellness providers in New York and provides confidential treatment and wellness services throughout the city. Bespoke has built its reputation on strong relationships, personalized, confidential service and a commitment to ensuring that all clients find the right treatment for their particular issues.

In addition to her role at Bespoke Wellness Partners, Limor is the Co-Chair of the Academy of Eating Disorders. She lives with her husband, three daughters and their dog Rex in Manhattan.

To sign up for our newsletter, or learn more about custom mental health, click here.