Let’s add “evidence-generating medicine” to “evidence-based medicine.” The goal should be to let the data guide on what works most effectively in specific populations of patients. This so called, real-world evidence will allow us to better understand which therapies work most effectively, taking into account the specific social circumstances, individual preferences, past history and genetic makeup of individuals.
As a part of my interview series with leaders in healthcare, I had the pleasure to interview Dr. Graham Hughes. Dr. Hughes serves as the Chief Executive at Sutherland Healthcare. He provides global leadership for operations, sales, management and strategy for the company. Dr. Hughes is responsible for the overall execution of the company’s growth plan, expansion of strategic partnerships, as well as the design and realization of the company’s strategy and vision. Dr. Hughes is a physician with more than 30 years of U.S. and international experience leading teams in the development and delivery of innovative healthcare IT products and services. Prior to being named the Chief Executive, Dr. Hughes came to Sutherland Healthcare as the Chief Medical Officer and Head of Global Analytics. Before joining Sutherland, Dr. Hughes served as Chief Medical Officer for SAS Institute responsible for strategic portfolio planning and leadership of the Center for Health Analytics and Insights, an incubator group for creation of new advanced analytic offerings. He has also held senior strategic and operational roles at GE Healthcare IT, leading the advanced technologies innovation team, as well as spearheading the annual strategic planning process for GE’s enterprise portfolio of IT products. Dr. Hughes holds a B.S. in Developmental Neurobiology and earned his medical degree, from Kings’ College Hospital in London. He currently resides in Seattle, Washington with his wife Heather.
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 started my career as a physician in the UK and have worked in both the UK and the US on healthcare IT software and services for nearly 30 years. I have had the privilege of working with some of the pioneers in healthcare informatics and also some of the best CMIOs and CIOs in global healthcare. I retain a passion for making health and healthcare better for patients and caregivers alike… under a sustainable payment model that rewards value. At Sutherland, the majority of our contracts are outcome-based, so we have shared incentives to do better for our customers and the patients and members they serve.
Can you share the most interesting story that happened to you since you began leading your company?
At Sutherland, we focus heavily on corporate social responsibility and giving back to the communities we work in. While visiting a local middle and upper school that we support in Hyderabad, India, I was particularly impressed by achievement of the girls who had collected most of the honors. When speaking to the local teacher, he said that the biggest game-changer that we had sponsored was not the clean water filtration system, but the building of a separate girls bathroom. Prior to this, the children had to share a bathroom and the older girls would not attend school when they had their period, as they were too embarrassed. It made me realize that sometimes the most effective interventions are the ones that you wouldn’t think about until you really dig into individuals’ motivations, fears and aspirations.
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?
During my first trip to our India offices, I thought I’d try to say a few words in their local language. Despite my best attempts at pronunciation, what I thought was “Thank you for such a wonderful welcome,” apparently sounded more like “I have gifts for everyone.” No wonder I was receiving such enthusiastic cheering and thunderous applause.
What do you think makes your company stand out? Can you share a story?
Beyond our work in corporate social responsibility as mentioned above, I believe that Sutherland stands out in part due to the commitment to taking a user-centered design approach to all customer issues. We always start by journey mapping the problem space and ensuring that we have a good baseline understanding of the “as is” situation, including as much data as we can. For example, we recently hosted a group of 13 different health plans at our Design Studios in San Francisco, where we spend two days diving deep into the challenges and opportunities associated with maintaining accurate information about physicians in network. Many attendees said that this was the first time any company has actually worked with them to really understand the details of the issues and to brainstorm with other customers on the most viable future solutions.
What advice would you give to other healthcare leaders to help their team to thrive?
Think of yourself as a master gardener of a large estate. You need a vision of how your garden will look during each season and that has to be cascaded to your team. You need the roadmap, talent and tools to achieve that vision. Even when you start on the journey, you can’t ignore the part of the garden that you have completed, otherwise it will become overgrown.
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?
The US health system is really optimized as a sickness management system. In fact, we are world-class at fixing problems when they occur, for those who have ready access to care. The challenges are well known: 1) We have a complex payment system that is primarily optimized around the volume of care delivered, rather than the quality of the outcome, 2) We have minimal focus on preventative care and proactive community care, particularly for mental health, 3) We have inadequate access to care as millions of people don’t have health insurance, and therefore only rely on the health system when they are in some form of crisis, and 4) Cost is shifted from the government to commercial insurers, who in turn pass that cost onto the individual in the form of co-pays and high deductible health plans. These factors all contribute to a system that is bloated and doesn’t serve the needs of the citizens in a way that many other higher income nations do.
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) Aggressively incentivize value-based payment models, such as episode-based bundled payment models. These models align incentives more effectively across patient, provider and payer around higher quality outcomes. Inappropriate levels of care variation (under- and over-treatment as well as avoidable complications) are penalized and higher performers are rewarded.
2) We need to include the voice of the patient in understanding individual goals, beliefs and preferences. For example, a patient with cancer may prefer palliative care sufficient to allow them to attend their daughter’s wedding and not be in pain… rather than having aggressive therapy.
3) Medicaid expansion is important as it gives individuals the access to care that they need. If states want to tie coverage with specific pre-conditions around job-seeking or other activity that is fine, but withholding health coverage from millions of individuals just because they don’t earn enough doesn’t make sense and creates a sicker nation.
4) Telemedical consults and other 24x7 access services need to become the new normal. It doesn’t make sense in this day and age — where we can order anything online, from taxis to takeout food — that we have to take time off work to go see the doctor at a time that is convenient for them. Retailers understand this and are getting into healthcare in a big way. Affordable 24x7 access to health services is inevitable, but needs to be linked with data interoperability to ensure our records don’t become fragmented.
5) Let’s add “evidence-generating medicine” to “evidence-based medicine.” The goal should be to let the data guide on what works most effectively in specific populations of patients. This so called, real-world evidence will allow us to better understand which therapies work most effectively, taking into account the specific social circumstances, individual preferences, past history and genetic makeup of individuals.
Ok, its 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: We need to behave like the consummate consumers we are. We should take our hard-earned dollars and place them with the best health plans, best doctors and best health systems. In other words, we should demand data transparency, so we can select the right health plan and the doctor who is most likely to be able to deliver the outcomes we care about.
Corporations: Corporations should negotiate aggressively and collectively to ensure that health systems are incentivized to deliver high-quality outcomes, and that health plans collaborate to provide services proven to improve the wellness of the staff they employ.
Communities: In the US, we live in much more fragmented communities that in many other parts of the world. Loneliness and support for the elderly and infirm are major contributors to morbidity. We can all do better in terms of supporting our extended families, neighbors and the wider community. Volunteer or support local organizations that help families in need.
Leaders: Leadership is local. If you run a business, start to explore ways that your employees can get healthcare support 24x7. Look at implementing wellness initiatives and visiting doctors or other health professionals. There is so much that we can do, if we start thinking about the health and wellness of our teams.
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 believe that there is too much separation between mental health and physical health. Many of the deeper challenges we face with the 5% of patients who account for 80% of the cost of healthcare are related to mental health, substance abuse and social circumstances. The general healthcare system is treating only the symptoms rather than the root causes of our health system’s challenges. We need a fundamental change in the way we train our medical and nursing teams. We need to change the incentive models to ensure that mental health screening and intervention is well compensated. We need to invest more in regional and local feet on the street as well as institutional support for mental health issues.
How would you define an “excellent healthcare provider”?
I’ll take competence as a given. After that I would say that an excellent healthcare provider is one who is available when needed, actually listens to the patient, is empathetic to their specific circumstances and engages them in the decision-making process and ongoing plan of care.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“In the end, it’s not the years in your life that count but the life in your years,” says a great deal to me. In healthcare and many aspects of our life, we should focus on quality of life and less so on quantity. And of course, the golden rule: “Do unto others as you would have them do to you.” This is frequently missed in healthcare settings, where individuals are often dehumanized as “patients” and not treated with the dignity and respect they deserve.
Are you working on any exciting new projects now? How do you think that will help people?
At Sutherland Healthcare, we are working on making self pay more transparent and individualized using advanced analytics and AI tools. We are all paying an increasing amount from our own wallets on healthcare — after insurance — and yet the bills we receive are almost undecipherable. We are working on ways to improve the experience, reduce surprises and make sure that we provide more of a personalized retail experience when having to pay for care.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
Atul Gawande’s writings are always on the mark. They call out the problems in the healthcare system as well as ways in which we need to change. The challenges are large but he is always able to crystalize incremental steps that can be taken to move the needle. I also enjoy reading the classic Patrick Lencioni books on team management, as the lessons appear so simple and yet applying them well is deceptively difficult.
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.
I would encourage organizations to invest in initiatives like the Champion Academy, which adopts an extreme mentoring approach to underprivileged teens. Giving hope, a helping hand and a good start in life to children and teenagers is as good as it gets and the payback is enormous.
How can our readers follow you on social media?
Thank you so much for these insights! This was so inspiring!