Naji Gehchan: Hello, leaders of the world. Welcome to spread love in organizations, the podcast for purpose-driven healthcare leaders, striving to make life better around the world by leading their teams with genuine care, servant leadership, and love.
I am Naji, your host for this special episode in partnership with MIT Sloan Healthcare and BioInnovations Conference, an event that brings the Healthcare Ecosystem Together. I am joined today Assaad Sayah, President and CEO of Cambridge Health Alliance. Assaad was named CHA’s President and CEO in January 2020 after serving as the interim CEO since June 2019 and chief medical officer since 2013. Before that, Assaad served as the chief of emergency medicine and senior vice president of primary care. In the Emergency Department, he led tremendous advancements at all three CHA hospitals, resulting in enhanced efficiency, quality, volume and patient satisfaction. He spearheaded primary care growth by more than 50 percent, expanding CHA’s access in underserved communities and integrating primary care and behavioral health services and systems to address social determinants of health. Assaad also plays a key role in CHA’s commitment to the communities it serves, including his tenure as the co-chair of the Cambridge City Manager’s Opioid Working Group established in 2018 to develop recommendations for strengthening the city’s response to the opioid epidemic. Additionally, Assaad is Assistant Professor at Harvard Medical School. His research and publications focus on operational efficiency, improving the clinical environment and patient experience of care.
Assaad – I’m humbled to have you with me today!
Assaad Sayah: It’s a pleasure, Naji. Thank you. It’s, uh, truly an honor being here.
Naji Gehchan: Before we dig in, value-based care, the topic of your panel at UH, S H B C, I’m eager to hear your personal story. What brought you to Medicine, er, and now running Cambridge Health Alliance and having such a tremendous impact on the communities you serve.
Assaad Sayah: Well, I appreciate it. Um, um, and, and, uh, it’s a long story, but I will keep it abbreviated. Uh, as far as medicine, um, this is, uh, calling, uh, I, as far as I can remember, I always wanted to be a doctor even before I knew what doctor’s all about. Um, I am the, uh, first, uh, college grad in my family. Nevermind, uh, a medical, uh, uh, professional.
Uh, and, uh, I have the, uh, truly the, the, the privilege of, uh, of representing, uh, my community and, and my ethnic background. I am Lebanese in origin, um, in the, in the greater Boston area. Um, medicine, uh, to me is, is truly more of a calling than, uh, than a profession. And, uh, what, what got me into emergency medicine?
Is two reasons. One, um, I am an adrenaline junkie by, by nature. So, uh, uh, anything, uh, that, that, uh, that’s up and running and, and exciting, I’m into it. And, uh, the second and more important thing, um, it is truly doing the right thing. Cause historically and even, uh, currently the emergency department is the only place where anybody can get care, regardless of their ability to pay 24 7.
And, uh, you know, this is a place where you get care and then we ask you for your insurance card versus anywhere else. Uh, as far that I know, you, you have to present your insurance card before you get your care, uh, for whatever it’s worth. That’s what brought me into, into emergency medicine. Uh, what got me into, um, Uh, into administration is curiosity and, um, uh, my, uh, difficulty in accepting things, not working very well around me.
So I always ask the question, how can we improve things? How can we do things better? And when you ask those questions, people say, well, go at it. If you can do it better, go ahead and give it a try. The more you try, the more you do, the more people ask. And one thing led to the other. And here I am, the c e o.
Wow. Thanks so
Naji Gehchan: much for sharing. Uh, let’s start now with value-based care. Uh, how would you define
Assaad Sayah: this? So, uh, value-based care, um, is, uh, is the combination or the formula that combines. Quality and cost. So if you, if you wanna say value equals quality over cost, the higher the quality, the better the value, the lower cost, the better the value.
The worst situation is an environment where you have low quality and high cost, no value at all. So you wanna improve to the best that you can, to the best you can, the level of quality while managing the cost. And, uh, the difference between, uh, Current value-based care and other attempts at managing healthcare cost is, is the equation that involves quality before.
Because if you go back to the nineties, uh, during managed care, it was only managing cost and there was no alignment of incentives. And with value-based care, one would think that the incentives are aligned between the patient who want the best quality. The organization that wants to provide excellent quality and get the best reimbursement and the payer that wanna manage cost.
And hopefully that combination is the magic sauce that will lead to the best work and the best healthcare environment.
Naji Gehchan: So you’re touching, uh, you touched upon those, um, the key players. So can, can you frame specifically who are the key players and what really needs to change today for us to be able to achieve?
High value based care.
Assaad Sayah: The, obviously the, the, the, the, the three major players in healthcare. I mean, there’s a lot of players you will add the government and policy makers and communities, et cetera. But the, the, the three big buckets are one, uh, the consumer, that’s the patient. And that’s the most important piece of all of healthcare.
We are all here for the patient to do the right thing. And the patient, what the patient wants is great quality and the best experience possible that is timely. Um, and that there’s a level of commitment and trust. Cuz trust is absolutely critical in healthcare. What the provider wants is, uh, the appropriate resources to provide.
The needs and meet the need and exceed the needs of the patient in an efficient way. And that requires funding and the right policies and the right pro, et cetera. And the right training. And what the payer wants is a partnership with the provider where when they give the provider the resources, cuz the payer doesn’t, uh, practice medicine.
The payer is basically the vehicle between the patient that’s paying premium. And the provider that’s providing the care, and they wanna make sure that as the care is provided, provided, it is provided at a good, qu good cost at the good price. The new paradigm is adding quality to the equation, is putting certain metrics, uh, that are reportable, that are measurable, that at least directionally define the level of quality that is provided.
Naji Gehchan: So do you think we’re well equipped? As a society to get there and, and really I would love your thoughts on health equity within the scope. Yeah.
Assaad Sayah: Um, we still trying as far as value-based care and in my opinion so far it is the, the best formula that has the highest probability of success. Um, Believe it or not, healthcare, uh, in general in the United States is all still, um, fee for service, which means you do something, you get paid for it.
Just like, you know, when you, when you call a plumber or electrician to your home, they come, they do the work, you pay them, they’re done, but you don’t know, you can’t evaluate the quality of their work. It could be great for the first day, the first week, the first year, but it could falter after that. And that’s basically fee for service.
There’s an hourly rate. You get paid for it. The incentive in here historically is the more you do, the more you get paid, but that’s not good. At the end of the day. You wanna make sure that you get the best quality, the best value for that job that you are giving to your plumber. Let’s, let’s say that. In the value, in the, in the, in the value-based care, basically, you get paid a certain amount to provide a certain amount of care at a high quality.
So the best way to cut down the cost is provide less. Care or enough care, but with the highest quality possible. And that’s how you manage the level of the cost of healthcare. That’s really going above and beyond. It’s always almost 30% of the G d P today, and some reports say that it’s higher than that.
So it’s gonna break our society if we really don’t manage our cost. Now, when you add the, the equity to the form, the equity piece to the formula, And as a healthcare organization, we are the only public hospital in the state, and our mission is to serve a, a safety net, uh, population historically and continuously.
And that population historically has been underserved and, uh, under-resourced at all levels, including with healthcare, uh, because one. The, the demand is greater. Uh, this is a patient population that has a lot of complication, whether it is mental health or social determinants of health, food, transportation, housing, you name it.
A lot of this patient population is, um, first generation immigrants. Many, uh, they don’t speak English. They have issue, issue with housing density. Many families are, are living in very small sh very tight knit, tight quarters. So there’s a lot of challenges in here. They’re all working, uh, difficult, many low paying jobs to really make ends meet.
Which complicate things. They complicate the ability to get healthcare. They complicate their ability to get, uh, to be transported there, to make certain appointments, to take time off of work. Uh, when they get there, their ability to communicate, understand, and follow directions, ability to get medications and follow medications.
That patient population is very complicated anyways. Not only the immigrant patient population, but also. Uh, the, the patient population that, that is, um, uh, less resourced from multiple ways, whether it’s financial, societal, uh, education wise, or even their ability to have access wide. Um, that’s what equity, uh, uh, plays a big role because historically, uh, we have not invested as a society.
In improving the condition, the, the living condition of, of that subpopulation so we can provide them, so we can keep them healthy and not only care for them when they’re sick.
Naji Gehchan: So can we double click on the, on this, because I know you’re doing a huge work, uh, and impacting those underserved population and you, you shared about social determinants of health.
So can I, can I get your view about this and how you have been leading your organization specifically to improve healthcare delivery for those underserved communities?
Assaad Sayah: Uh, one is you have to identify that community. So we are in the community. Uh, we do have, uh, um, 12 clinics out there all embedded in, in our communities.
Um, All our clinics, uh, have, um, primary care and behavioral health, and to a certain extent even dental involvement. So we can provide comprehensive care to the patient when they get care, get their, not start sort of shuttle them all over the place. Um, we have, uh, invested in, um, in our, um, Uh, multicultural department and, and that’s a department that is for the community, by the community that provides not only, uh, interpreter services, uh, but also support in multiple ways, uh, uh, speaking over a hundred languages, uh, out there, available in person and, um, uh, um, sort of virtually, uh, in our, um, Our ambassadors are not only there to interpret when the patient shows up, they’re also there to support the patient in their community.
So, um, you know, if they need their medication, they’re connecting them with the pharmacy, finding ways to get the medication at a discount, uh, or for free, uh, linking them to certain, uh, resources, um, and grants so they can get appropriate support, not only in healthcare. But in housing, housing, food, social services, et cetera, uh, going with them to follow up appointments, uh, you know, advocating for them, uh, when it comes to immigration, law, et cetera.
So they’re involved at all levels, not only to support that community, their community, cuz they come from that community, uh, uh, in only in the interface with healthcare, but in general to make their, uh, their environment more conducive to being healthy. I
Naji Gehchan: love that being, being there with them. It’s, it’s powerful.
I will now give you a word and I would love your reaction to it. The first one
Assaad Sayah: is leadership. Uh, leadership is, um, setting a strategy and creating a team, uh, that is committed to this strategy and to the work that needs to happen.
Naji Gehchan: Tell us more about it. I’d love to hear your story and how you do it with your teams, cuz you’re, you have a large team committed and I’m sure you’re, you’ve gone through a lot, uh, with, with pandemic and even today with everything’s happening around you. So I’d love, uh, to know how you keep your people engaged towards this purpose.
Assaad Sayah: I mean, uh, the, the, the most important, um, Role of of A A C E O and I call it be being a cheerleader. Uh, you have to be positive. You have to smile, you have to be a resource, you have to be available, uh uh, and you have to make sure that. Uh, you’re surrounded by people that are smarter than you, uh, and that I believe in, in the mission and the work that you’re doing.
Uh, because one person cannot change the world, they cannot, you cannot do the work yourself. You have to provide the environment and the resources for the people to do the work and the space. Uh, for them to do the work. Uh, it includes trust, which is the most important element in a team. Uh, and it includes clarity, transparency, and accountability.
Uh, and it’s a two-way street. Um, you know, I, I work with my team as a family. Uh, God knows we spend more time with each other than their own, their own, our own families. And, uh, we rely on each other, uh, good, bad or or indifferent, uh, every day to really do the work and make sure that we are, um, uh, maximizing and optimization, optimizing the resources we have, the opportunities we have to better serve the community and support each other.
I love it. What about care delivery? Um, care delivery, you know, I, I, I don’t like that word, to be honest with you, that, that, that terminology, uh, because it’s so narrow, believe it or not. Uh, but, but in general, uh, care delivery is, uh, um, meeting and exceeding the expectation of, uh, of the patient in the communities.
And, um, going above and beyond, uh, the healthcare system can do so much and has the ability and resources to do so much, unfortunately, that is not matched with the needs and it’s not matched with the expectations and the knowledge of, of the patients in the community. So we can do, we can do a lot more than than, than we do and, uh, and we should be able to do a lot more than we do.
So, um, care delivery is, Traditionally is the organization that provides care to the patient when they’re sick, when they need it. In my mind, uh, the best way to improve care is to, uh, provide, uh, what’s needed, what’s necessary for the patients to remain healthy in their communities and not need. Prevent them e every time a patient comes to the hospital or most of the time they come to the hospital, it is a failure of the care delivery system in my mind.
So the ultimate success is be out of business, believe it or not, and, and decrease the gotcha the needs, the traditional needs of the patient to really consume the amount of care that they consume.
Naji Gehchan: So true. You’re touching on prevention, how we do it, health
Assaad Sayah: education, absolutely. All of the above. All of the above 80% of people’s health or over 80%.
Happens outside the traditional healthcare system. It is what happens at home. It is the habits that happen at home, whether it’s, uh, smoking, obesity, you name it, drugs, alcohol, psychological issues, uh, food, transportation, you name it. Uh, that’s what influences people’s health. You know, there’s a, there’s a piece that’s related to the genes, what you’re born with, and there’s a piece that’s related to everything else we do to keep you healthy.
But the big chunk of it, uh, is what you do every day. And that’s what we need to invest, where we need to invest in early prevention, in screening, in early childhood, uh, screening and prevention in education of the families and the kids. So they have, uh, healthy habits so they remain healthy. So the third
Naji Gehchan: one is health equity.
Assaad Sayah: Um, health equity is, and this is not equality and this is not, it is basically, um, be thoughtful and purposeful in defining and bridging the gap. Uh, in the gaps in our society between the, um, safety net and the rest of the population, the population, that that has a gap. And so it’s not giving everybody an equal amount, it’s defining the gap and providing extra resources to bridge that gap at all levels, whether it is in healthcare or you name it.
There is equity in the, the digital divide. There’s equity in finances, there’s equity in education, there’s equity in healthcare, there’s equity in culture. I mean, you name it, there’s a historical gap, uh, that happened over decades and hundreds of years that, uh, The only way to, to, to, uh, mitigate that is to provide the appropriate resources to bring, to narrow that gap.
So the amount of growth and the amount of resources has to be exponentially greater here, so we can make up that gap with time. Otherwise, if it’s equal, there’s always be gonna be, there’s always gonna be a gap. The last
Naji Gehchan: word is spread love in organizations.
Assaad Sayah: Um, As I, we talked about trust. We talked about working as a family.
We talked about, uh, approaching things, uh, the way you wanna approach things, the way you should be approached things. And, and I have, uh, certain, um, rules that, that I live by. Uh, one of the rules that you hear about is, um, uh, you know, treat people as you wanna be treated. And, and that’s not my rule. My rule is you gotta treat people the way they wanna be treated.
Uh, because there’s a big difference. You can assume. How you wanna be treated. And, and that may not be satisfactory to others. And I think that’s a very important piece in love because you cannot, when in love, you cannot project your own definition. You have to project the other person’s definition of what love is about because that’s what matters is to the other person, is what they define it, not how you define it.
And that is true across all our society. Uh, and, and, If we approach things the right way, the way we conduct and live our life, not only professionally but with family and neighbors and society, I think that’s what matters is treat people the way they want to be treated.
Naji Gehchan: Any final word of wisdom has had for healthcare leaders around the world.
Assaad Sayah: Um, do the right thing. That’s another, that’s another piece. Um, and, you know, you’re always cha uh, seeing challenges and, uh, always facing issues that sometimes are insurmountable. But at the end of the day, we are all judged based on the work that we do. And, uh, at the end of the day, uh, the best way to be judged is for doing the right thing and sometimes.
Um, it may not be the most beneficial thing or the most lu most lucrative thing, uh, but doing the right thing always at the end of the day will lead you to the right place.
Naji Gehchan: Well, thank you so much. I, I can talk with you for hours, but, but I know you have to go and it’s been a really, an incredible pleasure to have you with me today.
Thank you so much for joining me.
Assaad Sayah: Pleasure Naji, and good luck to you. Thank you very much.
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