The US healthcare system is a tale of two cities. One city is magnificent. Even in the study you mention, the US ranks among the best in qualities such as effective care, speed of care, and focus on the patient. The other city is dismal. Again, according to the study you mention, US healthcare ranks among the worst in access and equity. Too often, a person’s ZIP Code is his or her health destiny. And it is enormously inefficient, when compared with other nations that are leaders in healthcare. Much of this has to do with healthcare insurance. Most people with good insurance — and by “good,” I mean coverage that keeps them from economic ruin, is affordable, and provides access to innovative therapies and care — are satisfied with their health care coverage. On the other side, one person in ten is uninsured, and millions more are under-insured, often because they can’t afford coverage or don’t have access to Medicaid, depending on the state. There are many ramifications to this disparity, including highly fragmented, highly expensive care that is too often delivered through the ER, and little access to services, like check-ups, that might prevent a lot of misery and expense later on. Even for those with decent insurance, the US underperforms in coordinated care, according to the study you mentioned. Primary care physicians often struggle to receive important clinical data from hospitals and specialists, and vice versa, which in turn prevents all the practitioners from providing the best care in the most efficient manner. The emblematic example of this is the clipboard plus questionnaire that too many patients still get when they go into a physician’s office. At a time when every hotel chain knows my information and preferences the minute I mention my name, why can’t my healthcare system do the same? Yawning gaps in insurance and coordination have knock-on effects: administrative costs that soak up money better spent on patient care, frustration for all in navigating a broken system, discouragement on the parts of patients and clinicians.
As a part of our series about the “Five Things We Must Do to Improve the US Healthcare System” I had the distinct pleasure to interview Freda Lewis-Hall, MD. Dr. Lewis-Hall is the Chief Patient Officer at Pfizer Inc.
Thank you so much for doing this with us Dr. Lewis-Hall. Can you share a bit of your background with our readers?
During my 35-year career in medicine, I’ve served patients in diverse capacities: inner-city physician, medical school professor, healthcare policy advisor, biomedical researcher and now as a leader in a global biopharmaceutical company. The common thread of all these roles is my passion for patient advocacy, at all stages of care.
Today, I serve as Pfizer’s first-ever Chief Patient Officer. I lead our company’s integrated efforts to make certain that the patient is always at the center of our work. This means hearing and heeding patients at every point in the process of inventing a new therapy, proving it safe and effective in the clinic, and making sure it is available and accessible to those who need it. We listen closely to patients and caregivers, and to the organizations advocating for them, and anticipate and respond to their needs. We want the best outcomes for patients now, and for those awaiting new therapies.
One of the most-satisfying dimensions of my role at Pfizer is taking the message about “patient power” directly to people around the world. That’s a message I offer through TV appearances on programs like The Doctors and Dr. Phil, and through a website, GetHealthyStayHealthy.com. Much more important, I partner with more than 90,000 Pfizer colleagues worldwide who are amazing ambassadors for better global health and wellness.
I trained as a psychiatrist and began my medical career working with patients in communities where mental health services were either poor or nonexistent. Later, and prior to making the transition to research-based biopharma, I was a medical school professor at Howard University College of Medicine, where I had earned my medical doctorate, and an advisor to the National Institute of Mental Health. I joined Pfizer in 2009 as Chief Medical Officer. My corporate experience also includes leadership roles with Vertex, Bristol-Myers Squibb, Pharmacia and Eli Lilly.
Can you tell us a story about what brought you to this specific career path?
I’ve wanted to be a physician since age six. I was inspired by our family doctor who always went the extra mile for his patients and was a highly positive force for good health in our working-class community. I was also inspired by an uncle, a polio survivor, who lived with us. People don’t remember the toll of polio before Salk and Sabin vaccines, but my uncle was seriously disabled by the disease. My job as a kid was to help him every morning to put on these huge leg braces that enabled him to be mobile and earn a living. I learned a great deal from him about overcoming adversity, as well as the noble work of medical care.
Both my parents were instrumental in encouraging me, and enabling me, to follow my dream of becoming a physician. Both were wise mentors and strong motivators. One story: I had a guidance counselor in high school who told me I wasn’t suited for college, even though my grades were among the best in my school. I was stunned and discouraged. My mother said, “We are finding you a school, tonight.” We went out, bought every college guide we could, spread everything out on the kitchen table and applied to the best schools in the country until the application money ran out. I enrolled in Johns Hopkins the following September — and finished in three years.
The launchpad for my current role came in one of my areas of therapeutic focus: helping those suffering from depression. In the 1980s I found that biopharma companies had invested heavily in the clinical research on depression and I wanted to be part of new wave of therapies that would reshape treatment for the disease. The transition to biopharma wasn’t easy, but I found great satisfaction in knowing that instead of serving a relative handful of patients, I could make a difference in the care of thousands, or even millions of people. I also found that I could serve patients best at the intersection of advocacy, patient care, and medical science. That led to Pfizer, and now, to my role as Chief Patient Officer.
Can you share the most interesting story that happened to you since you began with your company?
My responsibilities with Pfizer carry me far and wide, all over the world, so I’ve been fortunate to meet and learn from, many, many inspiring people who in one way or another demonstrate the universal human aspiration for good health. So rather than stories, let me relate some scenes.
Rwanda — working alongside clinicians in a village health center. Outside the center, a long line of people, mostly women, who have traveled for hours, infants in tow, for the chance to be seen by a physician and be vaccinated against disease.
India — a tour of an acute care heart hospital founded by Dr. Devi Shetty, whose innovative approaches to surgery and aftercare have made the most exotic forms of open-heart surgery affordable to millions of people who would have likely had a bleak prognosis.
Washington DC — in my home city, listening to kids, all of them living with rare diseases, connecting with each other, sharing their experiences, and eager to talk to others just starting their patient journeys.
My life, thankfully, has been one long, blessed, inspiring and interesting story. I’ve learned this much: globally, there are cultural, economic, legal, social, technological and even philosophical barriers to consider when trying to help people live healthier, longer lives. But the experiences gained in traveling the world and meeting with people from all corners of life have given me and my Pfizer colleagues deep insights into how we can move ahead to meet patients’ needs, today and tomorrow.
Before we get into the more-serious stuff, can you share a story about the funniest mistake you made when you were first starting? What lesson did you learn from it?
Here goes: I had just made the transition from academia to industry, and I learned the hard way that I didn’t know enough of the terminology used in corporate life. I was in one of my first cross-functional team meetings and after a thorough presentation by a senior colleague, he asked if I agreed with his conclusion. I did not. I said so, and stated my rationale. A brief debate ensued. Then, he leaned over and said, “OK, maybe we could take this ‘offline!’”
Hey, I grew up in a tough neighborhood, and I thought he was challenging me to “take it outside.” My eyes narrowed, and I said something along the likes of “You want a piece of me? Let’s go!” When he said, “Freda, I just want to postpone the discussion until later” I was embarrassed but my career survived the incident and he became a wonderful supporter and mentor.
The lesson — every culture, and especially corporate culture, has its lexicon. It’s best to learn it.
What do you think makes your company stand out? Can you share a story?
As you can see, I’ve worked with a number of organizations, all of them good ones. I’ve met thousands of dedicated people, including many in biomedical research who devote most of a career to pursuing one breakthrough that will blossom into a needed medicine. My focus on patients is not unique. It’s in the DNA of our company, and in virtually all the people I meet in the life sciences.
What genuinely differentiates Pfizer, in my view, is our company’s willingness to take on enormous challenges. I’ve learned, and appreciate, that Pfizer rarely says, “It can’t be done.” One virtue of the company is that it is used to taking the long view and investing over a long period of time, as long there’s a goal in sight, a plan to get there, and accountability for results. That’s integral to serving patients because, realistically, it takes one or two decades for a laboratory concept to be translated into a well-accepted treatment.
Pfizer’s engagement in the International Trachoma Initiative is one example of where the company took on a huge challenge and pursued it for many years. Pfizer co-established the ITI with the Edna McConnell Clark Foundation back in 1998. The vision was to eliminate a horrible disease, called blinding trachoma, in the 2020s. This disease is caused by a bacterium and routinely blinded millions of people each decade, until a Pfizer medicine was found to be effective in its treatment. But the medicine alone isn’t enough — patients also need simple surgery, access to clean water, and the knowledge to keep the disease from spreading. Pfizer donates the medicine, others in the collaboration provide the allied resources, and we all hold each other accountable for progress. In a world filled with missed deadlines, ITI stands a very good chance of largely eradicating a disease that has haunted humanity for thousands of years.
What advice would you give to other healthcare leaders to help their team to thrive?
I learned a lesson from a mentor, and one of the nation’s best surgeons and physicians, Dr. Lasalle Leffall, Jr. He was unflappable even in the most difficult of circumstances. He called it “equanimity under duress” — the calm to make the right decisions and the confidence to inspire others to get things done. An absolute must in the operating room, and good advice for all leaders.
Ok, thank you for that. Let’s jump to the 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?
The US healthcare system is a tale of two cities.
One city is magnificent. Even in the study you mention, the US ranks among the best in qualities such as effective care, speed of care, and focus on the patient.
The other city is dismal. Again, according to the study you mention, US healthcare ranks among the worst in access and equity. Too often, a person’s ZIP Code is his or her health destiny. And it is enormously inefficient, when compared with other nations that are leaders in healthcare.
Much of this has to do with healthcare insurance. Most people with good insurance — and by “good,” I mean coverage that keeps them from economic ruin, is affordable, and provides access to innovative therapies and care — are satisfied with their health care coverage.
On the other side, one person in ten is uninsured, and millions more are under-insured, often because they can’t afford coverage or don’t have access to Medicaid, depending on the state. There are many ramifications to this disparity, including highly fragmented, highly expensive care that is too often delivered through the ER, and little access to services, like check-ups, that might prevent a lot of misery and expense later on.
Even for those with decent insurance, the US underperforms in coordinated care, according to the study you mentioned. Primary care physicians often struggle to receive important clinical data from hospitals and specialists, and vice versa, which in turn prevents all the practitioners from providing the best care in the most efficient manner. The emblematic example of this is the clipboard plus questionnaire that too many patients still get when they go into a physician’s office. At a time when every hotel chain knows my information and preferences the minute I mention my name, why can’t my healthcare system do the same?
Yawning gaps in insurance and coordination have knock-on effects: administrative costs that soak up money better spent on patient care, frustration for all in navigating a broken system, discouragement on the parts of patients and clinicians.
You’ve seen the healthcare system from a variety of perspectives. Given your vantage point, if you had the power to make a sweeping change, can you share five changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
Sure. I will preface my thinking by saying that until everyone in America has affordable access to quality healthcare coverage, the nation is still going to have a systemic problem. Our current “tale of two cities” is not sustainable. We can’t strand millions of people without access to good care, and expect an effective, efficient, equitable system. Every high-income nation ahead of us in the study you mentioned ensures that every citizen has access to healthcare.
While we are working on more systemic solutions, I would focus on the following — call it the “low-hanging fruit” of healthcare.
First, investment in the information technologies that enable seamless care. We are making progress, although the dreaded clipboard is still a fixture at too many points of care. Ideally, your caregivers would have secure access to your relevant medical records, in real time, and this access and their contents would be secure and under your control.
We are making progress. More and more healthcare systems are taking on this challenge, and the results are encouraging. A few months ago, I visited the Lou Ruvo Brain Institute in Las Vegas, part of the Cleveland Clinic. It was designed from the ground-up for Alzheimer’s patients and their caregivers. What struck me: not one piece of paper anywhere in sight. No massive record storage areas, no file folders in exam rooms, nothing. People come to the clinic, get outstanding care, and never see a form along the way. No clipboards. Just flowers for caregivers as a token of appreciation.
Second, go full bore against the largest and most costly noncommunicable diseases, which, by and large, are both treatable and preventable. Major categories of disease such as cancer, heart disease, depression, diabetes, coronary artery disease, stroke, and bacterial infections take too large a toll in this day and age, and cost well over $1 trillion each year in care and treatment. Many of these diseases are readily preventable and/or manageable with early diagnosis and care. It is absurd that, 70 years after the introduction of effective blood pressure medicines, half of all Americans with high blood pressure are still not properly controlled.
That leads me to my third recommendation: improve health competence and literacy.
We need to ensure that all people are well informed about how to manage their health. Americans seem to know endless details about the Kardashians but relatively little about their right as patients or even their health status. I was giving a speech not too long ago and asked the audience what side their hearts were on and you could see a large portion of the audience start the “Pledge of Allegiance” in their head, putting their hand on their heart. Thank goodness for reminders! The truth is, doctors are there to help patients, but patients must also remember that they are full partners in their health.
Fourth, and on a larger scale, analyze and then implement alternatives to the current fee-for-service healthcare model, and realign incentives so that there are rewards in keeping people healthy as well as in treating them for the most difficult conditions. The good news here is that we are beginning to make inroads here. I would love to accelerate the experimentation here as we strive for new forms of medical practice.
Fifth, and equally important, continue to invest in innovation. We are now peering into the origins of disease and can make enormous progress, including much more personalized treatments and new therapies for rare diseases. We are now seeing therapies that were just theories not that long ago. For example, despite all the advances, for the more than 6,000 rare diseases that have been identified, we only have effective treatments for a fraction of them. The reality is that the US is seen as the best place for biomedical research, and that is a strong lever for progress. Our nation needs policies in place that encourage and reward innovation and attract the best biomedical researchers to our shores.
Ok, it’s very nice to suggest changes, but what concrete steps would have to be done to actually bring about these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
Well, I could go through the four constituents you mention and give you a laundry list of action items. But I believe the core approach to raising American performance in healthcare isn’t only a question of what we should do. It is a question of what we should not do.
And what we should not do assure people that there are simple solutions here. There are not. The deep-seated disparities in access and equity that now mark our healthcare system won’t be bridged through shallow slogans through the politics of obstruction, or by demonizing one group or another in the healthcare ecosystem. Healthcare is now one-quarter of the US economy. Everyone in the nation is affected. We have a challenging road ahead of us if we want to be where we should be in healthcare — among the top nations in the survey, not at the bottom.
That said, I believe we can build effectively on the recognized strengths of the American healthcare system, and on the trends that are either emerging or apparent in personal and community health. I am by nature an optimist, and I am cautiously optimistic about change
America leads in healthcare innovation and in our willingness to invest in healthcare advances. Most Americans are still satisfied with their healthcare. The mortality rates of killer diseases, cancer and heart disease in particular, have dropped substantially, almost miraculously, over the past two decades. People are more health conscious than ever before, and it’s showing up in everything from our diets and to our devotion to exercise. The healthcare system may be failing in delivering healthcare and even in being a system, but the foundation is there for change and growth.
The constituents you mentioned are people. Each of us, as individuals, wields some powerful levers of change — including the power of the purse and power of the voting booth. Americans can build a healthcare system that reflects our national values, including compassion, fairness, choice, and acceptance of individual responsibility.
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?
Part of the challenge is that we are still working to change the way people understand mental health. It’s often thought of as different from physical health, and in some cases less important. People are told just to “deal with it,” as if mental health issues are less pressing, and can be overcome simply by force of will. There’s tremendous stigma involved.
We are now learning much more about the connection between mind and body. On the plus side, studies have shown that expressions of gratitude can lower blood pressure, mitigate sleep issues and increase immune function. On the other side, some physical problems — such as hyperthyroidism issues, diabetes and others — actually present themselves in emotional and behavioral issues. So, we know there are connections, and now, we are putting science to work to illuminate them.
How would you define an “excellent healthcare provider”?
I can’t. I just know it when I see it. I’ve seen physicians and nurses working under near-combat conditions — they were excellent healthcare providers. I’ve listened to physicians in their offices calmly explaining to patients the most difficult options, and doing so in plain language, and with compassion and sensitivity. They were excellent healthcare providers. I’ve been there when a major clinical trial fails, years of work down the drain, researchers trying to come to grips with their disappointment. And they were excellent healthcare providers. It’s a big, broad world out there, and excellence comes in many different forms. Common bonds include passion, compassion, caring and competence, whether we are talking about a newly minted nurse working alone in hospice care or a skilled surgeon at the top of the craft.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
My late father — he died this year at age 100 — was once a Pullman Porter on the intercity trains that crisscrossed our nation in the 1930s. He always told me “Be ready for the curves and the straightaways will take care of themselves.”
As a woman of color entering a series of male-dominated professions in medicine, academia and business, I had to be ready for lots of curves in my career — and wary of derailing.
I once asked my father how one should define a legacy. He said, “Your legacy is what you leave behind, who you bring behind, and what you learn along the way.” I have always kept saying that a guide star, to the point where a few years ago I wrote an entire book about that premise: Make Your Mark: Why Legacy Still Matters.
Are you working on any exciting new projects now? How do you think that will help people?
It’s exciting to come to a major leadership role that is both brand new and highly visible. One of my priorities as Chief Patient Officer is to enlist Pfizer colleagues as ambassadors to our patients and as advocates for them. There are more than 90,000 colleagues at Pfizer, working in just about every nation with a seat in the UN. I want them to go beyond the call for patients, as many of them already do, and to me, that’s about as exciting an opportunity as one could have.
I am also deeply engaged in a relatively new field, venture philanthropy, which takes concepts and approaches from the world of venture financing and applies to them to achieving considerable social benefit. With Pfizer’s support, I serve on the board of a company called SpringWorks Therapeutics, where we are using shared value partnerships with patient advocacy groups to explore new therapies for rare diseases. Very exciting work.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
I am impressed by a new book from Reshma Saujani, the founder and CEO of Girls Who Code. The book is called Brave Not Perfect: Fear Less, Fail More and Live Bolder. I like that she advises women to play boldly to their strengths and not to miss out on an opportunity because all the boxes aren’t checked on the job description. It’s time for talented women to raise their hands when opportunity arises and not obsess about being the absolute most perfect candidate for a new job.
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. :-)
A movement to empower people to take more control over their health. One that gets people talking about the most difficult topics without reservation or stigma. One that gives people license to voice the unasked question in the medical office. One that encourages people to volunteer as citizen-scientists, including involvement in clinical trials that will bring forward the cures of the future.
Everyone is a patient at some point in their lives — it’s one thing we all have in common. In a world of increasingly complicated and often-conflicting medical advice and information, it’s time for everyone to know where to go for help, and I am absolutely committed to that cause.
How can our readers follow you on social media and the internet?
If you’re on LinkedIn, please follow me as I’ll be sharing periodic updates, thoughts and commentary as it relates to a variety of healthcare topics and concerns. In addition, I share a wealth of useful information about personal and family health on GetHealthyStayHealthy.com.
Thank you so much for these insights! This was so inspiring!
Thank you! It’s been a pleasure.