The mission and vision for primary care physicians and other clinical personnel is to leverage data and modern solutions to craft holistic care plans for individual patients. Patient care plans are never black and white. A patient’s ability to pay for necessary medications or whether they have transportation to and from an appointment can make them deviate from a standardized care plan, affecting their outcome. Timely, targeted, and actionable interventions using a care coordination model that leverages whole-person design can help that patient get back on track.
In this episode of the In Network podcast feature Designing for Health, Vice President of Care Coordination at Corewell Health West, Tricia Baird, MD, sits down with Nordic Head of Thought Leadership Jerome Pagani, PhD, and Chief Medical Officer Craig Joseph, MD, to share her perspective and ethos on whole-person design. They also discuss the importance of incorporating empathy into hiring practices and how creating a better health experience is a moral imperative.
Listen here:
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Show Notes:
[00:00] Intros
[01:35] Dr. Baird’s Background
[06:37] Whole-person design
[10:18] LACE+ Scores and reducing hospital readmissions
[14:52] Keeping the work timely, targeted, and actionable
[19:19] Hiring for empathy and training for clinical skills
[28:02] Adapting value-based care models to fee-for-service
[29:50] Pairing clinical care with behavioral health
[34:08] Designing a better health experience as a matter of morality
[40:49] Things so well designed, they bring Dr. Baird joy
Transcript:
Dr. Craig Joseph: So, Dr. Baird, welcome to the podcast. We're excited to have you.
Dr. Tricia Baird: Thank you.
Dr. Craig Joseph: Now, as I understand it, you have always been interested in going to medical school and getting a business degree and combining those two things to becoming the king of the world, or in this case, the queen of the world. Is that true? That's always been your goal, or did it start off in a different way?
Dr. Tricia Baird: You know, I am so sorry that I may have to fact-check a little bit of your story.
Dr. Craig Joseph: Oh, this is just the beginning. It's going to go downhill from here.
Dr. Tricia Baird: Excellent. Well, in actuality, I was raised in a tight-knit community in the Midwest, very much fitting the national average. Right? The average American does not have an undergraduate degree or any advanced degrees. But we certainly enjoyed being in community with each other. I liked school a whole lot and ended up collecting some degrees in information. But what really stuck with me for my growing up was how much people really moved into adulthood in a way that would contribute to their community. I distinctly remember resuscitating a few people in the E.R. who, as they were coming back conscious, were trying to remember where they knew me from, from a daughter or a grandchild that I had gone to school with or played sports with. I've delivered hundreds of babies. I did full spectrum primary care in my medical practice, and I've coached softball in Little League for many of the kids that I delivered. We saw each other at the grocery store, at church, at school, out in the community. So that sense of all of us being accountable to each other, of us belonging to each other, was probably the first lesson I learned. I've learned a lot of other very technical business and medical things since then, but that that sense of community is very deeply ingrained in my raising.
Dr. Craig Joseph: Well, that's awesome. So I am just curious how, when you went to go get your business degree or MBA, was that like something that you knew you wanted to do, or were you out practicing for a while and then you're like, Oh wait, I need to be able to speak business?
Dr. Tricia Baird: Yes. A few people suggested that the problems I was bringing, the things I was interested in helping solve, would be better if I could speak business. After several mentors had suggested that, I looked into it. There are lots of ways for physicians to kind of dip their toe into the water of business planning and management. I liked that. It actually helped me in some of that problem-solving, and so I ended up working my way through the whole degree. I think a lot of physicians find themselves in that space. It wasn't an image I had when I went to medical school. I just wanted to help people. But at some point, helping larger groups of colleagues or patients or planning involves that level of business intensity. And it has served me well.
Dr. Craig Joseph: That's, I think that's not, it's becoming more and more common, you know, that medical school didn't teach you everything that you needed to know. So what is your role today? You're still practicing, I'm assuming. Are you still delivering babies? And what else do you do?
Dr. Tricia Baird: I gave up delivering babies about a decade ago. I hit that 500 mark and thought that was a good milestone. And I think that the pandemic might have killed my clinical practice. After we finished all of the emergency planning and prioritized clinical spaces and digital spaces for my full-time colleagues, it felt like we were deep enough into some of these design problems and problem-solving that I would just stay in that direction. But today, I serve as the vice president of Care Coordination for Corewell Health, which is the largest health system in Michigan. We've been focusing our design efforts in West Michigan but are working with our east and south regions to really bring these automation designs and software supports to the human interface, not only to help our patients, but to help improve the quality of the work our clinical teams are doing. We want them to be doing the connection and the problem-solving that they love doing and less of the paperwork and the identification of the next patient that is not in their native skillset. They really like helping the next patient and getting to the one after that with the right problem in hand. So the more we build these design pieces, the more they enjoy the work that we're asking them to do.
Dr. Craig Joseph: So, this is unusual, seeing physicians in Michigan apparently don't like doing paperwork.
Dr. Tricia Baird: You know, I think back on my medical school time, and I don't remember any of the classes required or electives that taught me how to type and document. Yet I find myself doing quite a bit of that in practice lately. So what started as an individual problem-solving for myself kind of caught fire. And I think a lot of us show up to have good relationships and solve problems. The more that we can put our clinicians in spaces to do that, the happier we all are.
Dr. Jerome Pagani: So, Tricia, you have an article out recently in the Catalyst that has one of the most wonderful titles ever. And in it, you talk about whole-person design. What is whole-person design?
Dr. Tricia Baird: Yeah, so whole-person design. Getting back to those lessons that I was taught in my raising, right? Everything belongs and in clinical care, when we can use data analytics to find people who aren’t naturally served by the individual disease protocols or the individual standard work that might work for someone who has only diabetes or someone who has only hypertension or is only recovering from a plain surgery. That whole-person design allows us to find people who might have all of those things, diabetes, hypertension, recovering from a surgery, and other issues, like I'm anxious about my ability to be myself fully, to show up for my household. I'm worried because I don't have safe transportation to and from my follow-up appointments. I'm feeling conflicted about whether to spend my money and my time on what I need or what someone else in my important family support system needs. We were finding that many of our patients who were having trouble navigating these single care pathways really needed someone to serve as that trusted advisor of How do I balance these competing priorities? How do I get what I need to be healthy? How do I connect with the health system? Who can help me? My home support system that can help me? And also give enough attention time, money, energy to the people in my support system who I love and who love me? When we allow that, everything belongs, that's what we call whole-person navigation. So getting the chance to identify the top segment of our patients who would most likely have complexity after they leave the hospital and then calling them the day after they leave the hospital and saying, Hey, would you like a friend for free to walk with you through the next month? We know some things. We've been through some of these paths, but you've never been through this. So can we walk through this together, starting with what's most important to the patient and then with, you know, which a little bit we start to wind in the things that are important to us too, in healthcare. But when it starts with what's important to the person we're trying to help, and they're driving the agenda. And the fact that two out of three of the people who would have readmitted in that population were able to find a path that was successful and stay home is really a testament to the fact that the patients driving, the patients in charge of their life, this is a person who is the expert on themselves, and we're there to assist.
Dr. Jerome Pagani: So, two things about that that I love. The scientist in me loves the looking at interaction of factors, because that's a complexity that really reflects the way real life works. You know, it's not all main effects. And the other one is that you start building the trust with the patient and designing for them, but you really are beginning to look at the relationship, the patient side and the physician side and are designing for both. And I think that's fantastic.
Dr. Craig Joseph: This is all very interesting. Let's get to some of the gory detail about how this actually happened. And, you know, you came to our attention because of this New England Journal Catalyst article. And in that article, you talked about reducing hospital admissions. I mean, that's a core part of your job, it sounds like. And you were using, your team was using something called the LACE score or the LACE+ score, and you found it lacking, and so what was it missing, and how did you fix it?
Dr. Tricia Baird: Sure. The LACE score and then the LACE+ score are well-known to most of us in U.S. healthcare. They are a validated tool that really does a great job for cardiopulmonary readmission prediction. It's not so lovely at predicting if you have social determinants of health, it does not directly factor in any behavioral health issues. And outside of the sort of traditional core medical specialties, it can struggle. So, dialysis, OB-GYN issues, just not really designed for that. Over time, if you keep readmitting because the system doesn't serve you, the score will start to populate that. But we don't really like to get people in the habit of taking on a sick persona or mindset. So our goal was really to find people who were at high risk before they developed a pattern that made that risk apparent to everyone. I think some people call that predictive analytics. We tend to think of it as a clinical crystal ball, but really we were in a moment a few years ago where the tools were finally coming into a really clinically useful space and the predictive analytic potential to do better than the LACE score was really exciting to us when we started this journey.
Dr. Craig Joseph: Did you kind of play around with things? You clearly came up with some, you know, some ideas like, Hey, social determinants of health might be important in predicting readmission risk, but there's lots of those, and some of those are more discreet than others. And how did you kind of go feel your way through that to find those people so that you could reduce the readmission rate so tremendously?
Dr. Tricia Baird: Sure. So, we had the LACE score, which we've talked a little bit about, which was really our best real-time prediction in the moment. And then there was lots of data that exists in a final paid claims kind of payer sphere. That final paid claims process typically tells me what happened four months ago or longer. So we needed something more predictive than the LACE score and more timely than those payer final claims data. And so, we found an artificial intelligence predictor for readmissions that came from our electronic health record and with some research, realized that there was one key factor that we felt was missing. There was no calculation in that artificial intelligence for the presence or absence of a primary care relationship. And if you're talking about connecting whole-person questions to a clinical team, not having a primary care physician was a critical risk for not being able to solve the problems you encounter a week or two after leaving the hospital. We were able to add a scoring element to the artificial intelligence that gave high points for having an established primary care relationship and half points for having a specialist who was functioning as your primary care doc. So, imagine if you have very difficult congestive heart failure or are in active chemotherapy, your oncologist or cardiologists are functionally acting as your medical home during that period. And so, we wanted to recognize that, while also recognizing that a cardiologist may not opine on other elements outside of their specialty. When we added that risk grouping, we were able to isolate one in five of all of our discharging patients as a particularly higher risk from the other four out of five and concentrate that whole-person transition support on that one out of five patients.
Dr. Craig Joseph: That's great. And I think that the idea that there are specialists that do kind of act as your as your primary care doc or as a medical home for you during an exacerbation, that does make a lot of sense, and they, I think often the specialists want to be in that role except for those things they don't want to opine about. Right. So they may not be an expert on when, you know, when you're supposed to get your numa vacs or, you know, other kind of preventative care stuff that primary care docs do much better with. But yeah, so how do you get them a PCP, or do you act as the PCP? Is that your hey, I'll be your friend for the next month until we can get you a PCP?
Dr. Tricia Baird: Yeah, great questions. So let me talk about three principles that really bounded this design and it will make sense then how we get them a PCP. So, this work needs to be timely, targeted, and actionable. The timely piece really speaks to are we identifying people who need help in a time frame where the help can be given? And that was really spanning the difference between these, you know, lagging payer claims and the LACE score that was real-time but wasn't really predictive. The second piece targeted are we able to isolate a segment of patients out of the entire population that are likely to benefit from the intervention rather than nominating the entire population into the intervention? And then thirdly, actionable. Have I identified people in real time that are not the whole population to the timely and targeted, but am I giving that information to a member of the team who has the time, the power, and the resources to do something about the problems that are about to crop up? So that gets me to the actionable part, gets to how we get someone to a primary care physician. Especially as we started this work, we met a lot of people who had taken many, many laps around the health system trying to get what they needed in their complex problem-solving. We really needed to acknowledge that their experience, their lived experience, meant that we had a lot of trust to work back with them, and we found that putting a nurse or social worker along with community health worker support into that space, focusing on their first agenda, their relationship needs built a relationship up over time. And it often took several handfuls of problem-solving and checking back, you know, at their best. So many of these patients have heard many of us say, I'm your friend, I'll be here. But we were often several days late and several solutions short the last time they decided to trust us. So, we really needed to lay several weeks of groundwork of, I can find an answer to that. Let's do it together. I promised. I was going to follow up, and I did. And I'm coming to ask again, what else is there? It's not. You know, I've solved two problems for you. Isn't that enough? Whatever it's going to take to get through this month to help teach you who to advocate to and what to say when you call. Within a few weeks, we develop a trusting pattern, and within a few more weeks we've developed enough trust that they're willing to trust other people we recommend into the relationship. All of our staff that does this transition work is very eager to get to the next patient who needs them for the next month. So, no one on our team is trying to keep these patients for the long term. But as we develop relationship and trust over those first two to four weeks, and we recommend them to a primary care doc or an ongoing care team that is open when they have a ride, is able to answer the questions, can communicate in a way that this person understands. We're making those matches and then leaving them at the end of the transition month with a go-forward team that really suits their individual needs.
Dr. Craig Joseph: So the folks that are doing the following up, I think you had mentioned that you kind of tell them some, that you give them some ideas about how to communicate. Is there, are there prompts, do these things show up in the electronic health record? How do you hire for this position? How do you predict people that are going to be, find people are going to be good at it?
Dr. Tricia Baird: Sure. So many of the roles on this team, many of the roles on care coordination team in general, we hire for empathy and compassion, and we train clinical skill sets, whether that's someone who has been an RN at the bedside or social workers who learn the teach-back and motivational interviewing techniques in their own training or community health workers for whom that empathy and compassion component is the most essential hiring piece. The lived experience of these healthcare navigations is the most important piece, and we can train the details of who to call and how to follow up and solve problems. Over time, this role on our team has become one of the most popular roles on the team. It is the job opening that stays open for the smallest amount of time. These are really, really fun jobs because you know every day what you did to help many people who wouldn't have had the help if we weren't there for. So the recruitment has been very easy. It's the self-recruiting job. The order of the work and the to-do items that happen are really divided into four weeks of a month. We try to schedule two touches with a patient every week of that month, and there are plenty of opportunities for follow-up and unscheduled touches. But this is where we try to temper our enthusiasm and experience and try to make space for patients. You hear a lot of people using that phrase lately. We talk about complex patients and value-based care making space for patients. For us, what that means is really being patient and listening in the first week again so that the person's agenda can make it under the table. Because I've been through thousands of transitions of care journeys, I have a pretty good idea what those 16 touches are going to be in the first month. But if I try to unleash eight of those touches the first time I talk to you and another eight the second time, I look like all the other people who are trying to check the boxes of their to-do list and leave. So we've very thoughtfully pulled those touches out over the course of a four-week period. And in the first week, a lot of our questions, unless the patient brings up something different, a lot of our questions look like, can you afford the medicines that you were prescribed? Do you understand who to make an appointment with? Do you have a ride to get there? Is there food in your refrigerator because you've been in the hospital for two weeks? It's very tactical survival. In the second week, we start to get into, you know, wow, that's a really heavy diagnosis or change in your health that you heard when you were in the hospital. How do you feel about that? Are you anxious? Are you depressed? Who’s your support system? In the third week, we get into things like what is your go-forward plan? We get a lot of, oh, I was told exercise. I can't exercise. What do you mean by that? Well, I can't run a 5k. Cool. I can't either. Can you walk to your mailbox? Yes. Can you walk to your mailbox three times by the end of the week? Yes. The next week. Can you walk halfway down your block and back? Yes. Can you walk halfway down your block and back three times this week? Right, all of the pieces and parts. I have dozens of stories, these are our favorite stories in the team, of people who find a way to get to a healthy lifestyle. But doing that step by step by step and we try to chart and negotiate a path for those steps with patients and then walk with them and follow up. It matters. We heard what you said. We care about this happening. We're going to walk with you. And once people start feeling better, not only with their medications and their treatment plan, but with their diet, with their activity, with their coping skills, and mindset, once you start feeling better, you find a way to stay better. But it can be awfully intimidating to get into that space of better. And that's what it means for us to make space for patients.
Dr. Jerome Pagani: You used a metaphor to talk about caring for a population of people that it’s more of a fishing net. Can you describe that for us and what you mean by that?
Dr. Tricia Baird: Sure. So, the fishing net emerged because you can hear us talking about design and data and information, and we like data points. In fact, all of those touches that happen over a month, we can track each one of those. We can tell which ones are successful in long-term outcome and how all those pieces are moving. So, it was natural for some people to ask us, which of those touches, which to me were the essential piece, which ones do I have to do and I can drop the other dozen, and we can just do the two that work? Our way of explaining that is if you've ever been fishing and you catch a nice, big, 12-pound fish, as you're trying to take it off the line, you usually sweep it out of the water with a net. Asking you which two of these interventions prevented the readmission is like asking which loop of that net caught the fish out of the water. It's the entire net. These journeys can go almost any direction because we've selected for complex patients. So, our ability to move in any direction with each complex journey is really the secret sauce.
Dr. Jerome Pagani: And that fits right back in with what you were saying before about the complexity of the patient that you're caring for. There aren't going to be single factors, or maybe even one or two factors, that are going to account for the type of care that that patient needs. It really is, you really are talking about that, the entire intervention, and I love how that metaphor fits right in there.
Dr. Tricia Baird: That's very fair. And, let me add, the majority of patients are incredibly well-served by the health system for the majority of their needs the majority of the time. Healthcare works. It is our special privilege to stand in the spaces for the minority of people who have a lot of interlacing instructions that don't make sense when they're interlaced. So we love being a day or two ahead of things that are likely to fall apart and making sure that they don't. Because once people know how to advocate for themselves, once people trust in their own skills, they do a wonderful job of taking care of themselves. And we're happy to be a special kind of team that helps a special group of patients find their way through that system. It's a lot to navigate.
Dr. Jerome Pagani: So, this is really some of the secret sauce that explains your team's success, this approach and mentality. And it sounds like, I hear you saying, this is a great mentality for some types of care, but it shouldn't be applied writ large to healthcare because, for the most part, it seems to work.
Dr. Tricia Baird: Yes, absolutely. And most people like being autonomous, right? I don't let someone else grocery shop for me. I don't let someone else cook for me because I know how to do those things. But if I would need that help for a short period of time, I know how to access that and find it. In fact, looking across a whole population and realizing that most of these healthcare journeys work. But what is needed differently for a small segment of patients? It's not only a secret sauce for this readmissions work, but it's a theme that moves through a lot of value-based care for me. For value-based care, you want to let the system do what it's doing successfully. You only want to tweak or improve what is benefited by the improvement. So a lot of our care coordination work really took on a much broader mandate when our health system boldly moved into total risk contracts in value-based care. And this is really a key component of supporting value-based care is thinking differently about a minority of patients that need a more intense intervention.
Dr. Jerome Pagani: And under a fee-for-service models, these are often the type of patients that cost the most anyway, right? Because they are, the complexity of care they require is much higher. The number of services they may be utilizing is going to be higher. Are there lessons that can be pulled into fee-for-service? So, I guess I'm asking is this: Is this approach adaptable outside of a value-based care model?
Dr. Tricia Baird: Jerome, it’s very adaptable. I don't think you would find anyone working in healthcare who says, Boy, if we could just freeze everything about my week exactly like it is and do the same thing for the next five years, I'd be so happy. And often, when we ask a little more about that clinician burnout and frustration, it's because, you hear words like noncompliant and phrases like, why would they do that? There's this adversarial sense that can crop into some of these complex journeys, because again, for a clinician that has a visible problem list, a prescription pad, you know, one disease journey, why aren't you following my path? Unfortunately, for complex patients, there can be four or five different teams wanting a patient to follow their path with highest priority. And when we can get into a space where the clinical teams are able to see the behavioral health issues and the social health issues that are sitting like an iceberg underneath the clinical health, it helps create the right questions and get to the right answers. It reduces frustration for the clinical teams, it improves the experience for the patients, and that curious space where a solution can move forward works no matter who's paying for the care or how the bill is arranged.
Dr. Craig Joseph: So, you brought up behavioral health and wisely said that that's often sitting underneath underneath the water like an iceberg. So, a patient’s diagnosed with a new onset diabetes or a heart problem that wasn't there. But they're not going to get better as well as they should because there might be either preexisting behavioral health concerns or diseases or something that was kind of just exacerbated by this new diagnosis. So your team is there for a month, maybe. How do you so you clearly are good at identifying these issues and kind of talking about them for a little bit. But how do you go about getting those folks care? I'm assuming that there's not an overabundance of psychiatrists and psychologists and social workers in Michigan.
Dr. Tricia Baird: You are correct, Craig, just like most of the Midwest, psychiatry and behavioral health is in short supply. And we find again that when we can identify triggers, clinical impacts, and then impacts on a person's overall health and well-being, that finding the individual triggers for two or three skill-building sets is really enough to get someone started off on the right path. So let me give you an example. If you have breathing trouble, if you have COPD, and have not connected that when you get anxious, your breathing gets even shorter. Or many people with COPD also have pain issues and taking narcotics or certain classes of pain medications depresses your respiratory drive. When either of those things happen, you get anxious, or you get into pain and you get into a shortness of breath cycle. You're already facing a lot of pressure as far as solving the short-term problem. People don't always think back two or three steps to what triggered that issue. But if we are able to make that connection for people, did you get into an argument with someone in your family in the morning and by the afternoon you were short of breath? After two days of that, you showed up in the E.R. Or did you extend yourself and, you know, walk further than you normally would to be part of an event you wanted to be at? Took extra pain medicine for a few days after and a few days after that ended up in the E.R.? How does your use of pain medicine, how does your anxiety or alternative use of coping strategies help you avoid that path that sends you into a shortness of breath cycle that you don't want? Is it possible that you could use walking assistance next time you go out to that social event so that you can take breaks and not create the amount of pain that pulled you into the trigger in the cycle? These are very granular examples of how far we get down in the weeds with someone, but when you find the right two or three triggers and really educate that, empower them, and put the solution back in their hands, people really do very quickly solve their own problems when the problem and the solution has been proven for them. The shorter version of me seeing that is we frequently find people in the hospital who get a new diagnosis of cancer when they're in the hospital. Obviously, the week after their discharge, we're working on, Do you have your follow-up appointments? Have you chosen chemo or radiation? Can you afford your medications? Do you need durable medical equipment or healthy food at home? But by the second week, we really start to explore with them. How are you feeling about processing this diagnosis? If you tell me you're not anxious or not depressed in any way, I'm feeling like you didn't hear me, that we told you two weeks ago that you have cancer. But when we don't deal with those feelings, when we don't unpack the pieces that surround that medication listen, that diagnosis list, we're not serving the ongoing journey that is going to lead to healing.
Dr. Jerome Pagani: Maybe this applies specifically to behavioral health, but the need to get in and see as many patients as possible and just to get through the volume of folks that you need to see in a day is real. And so, there's been a tendency to listen and hear as deeply as you can and write a script and send the patient off. And you've addressed this as a moral issue. Can you explain a little bit about what that means and how we might think about changing the way we actually care for patients as a result of that?
Dr. Tricia Baird: Yeah, great question. That is not a quick answer. We are making strides, particularly as we adopt this value-based care mindset. There is a little bit of a foot in both canoes here, right? The productivity treadmill that you talk about is much more of a reality in strict fee-for-service medicine, but especially accrual health, we are seeing great experiments because of that value-based space. How do we cohort groups of patients? As far down as light touch, episodic acute care that younger single-issue patients may appreciate being able to have a wellness visit or an acute visit from my desk at work with digital technologies to the middle stance of what looks a lot more like traditional primary care and office space, ongoing clinical relationships all the way up to the things that I'm describing our team doing in support of very complex primary care or deep single issue specialists working on a multi-month or multi-year journey for deep disease. Dividing these pieces into at least those three groups. The relatively well, the traditionally served, and the complex patients is really only possible when you're making bold business decisions like accepting full risk from the payer. The fact that Corewell Health is taking risk on these lives and that we're partnering with not only our integrated delivery system, we have a payer inside our delivery system, but with federal and state payers and other private payers. The way that we are making a bold choice to accept financial risk so that we can make clinical gain is really the only path to design this from the inside out to make an innovative, differentiated solution that works better for all of us.
Dr. Craig Joseph: Clearly, you think about design, you've mentioned design multiple times, and you seem to be a proponent of designing things before or before designing things, understanding what the problems are. And I see this in my world when people come to me and say, Hey, I have this problem and here's the solution. I want you to build for me from an IT perspective. And often they don't, they maybe know what their problem is, but they certainly don't know what the large options are. And they can't really design a solution as well, because that's just not what, they don't, you know, see the whole big picture. Are there other parts of your work where people have come to you with a solution to a problem and asked you to implement that solution when in fact, they should be going back to understanding what the problem is and then working with you to design a solution together, because you know what all the building blocks are that they may not know about?
Dr. Tricia Baird: Such a good question. I am intrigued by the idea of having someone bring a solution to me. That sounds so tempting at the beginning of it, but doesn't often happen. And honestly, anyone who knows me would tell you I would hate a prepackaged solution eventually if it were given to me. The tagline that we use a lot with our team is that there is no answer, we are the answer. So, let's get in the room and chart the current state of what we are doing and the current state of the problem that is not being served by what we are doing and try and find a map somewhere in the middle. What are the ingredients? We have to solve this problem and how can we reorder or redesign those to meet the reality of the problem as it exists? The quote that my team is very used to hearing comes from Scott Belsky and his book, The Messy Middle. We are going to have a plan and we are not going to plan on sticking to it. So if we don't have a design to start with, I can't take anything to our software building team and our data building team, but because we work in an agile mindset, we have a very headline and bullet points plan that we ask for the first build and then we want to see what the outputs are of that build and then refine it. So, using that idea of no one knows what's actually happening better than the patients and the clinical teams that are at that space, we design from a very realistic ground up. Start. And then with incremental builds, we start with those big chunky evaluations and move into refinements based on the feedback that we're getting. It's a very clinical way to design. Clinicians know how to get vital signs, get labs, ask the patient how they're feeling and make a plan and then have them come back, whether it's a few days, a few weeks or a few months. You start again with that realistic feedback and amend the plan. So I guess I used that business degree that I got last to drive back to all the things that we all learned as clinicians at the bedside. That scientific method is ingrained in all of us in healthcare, whether we do it formally or informally. We're all curious about the world. And I don't see non-healthcare design as very different from the way that we problem solve as clinicians at the bedside. But putting those mindsets together really gets teams excited and moving around that bringing that partnership with our data builders, our software builders and that well-ingrained clinical mindset has been a winning combination for us.
Dr. Jerome Pagani: And Tricia, we've come to my favorite part of the podcast, although I've enjoyed all of your answers so far. But this is where we ask people for two or three examples, and they can be outside of healthcare, but two or three examples of things they interact with on a regular basis that bring them joy to use.
Dr. Tricia Baird: All right. So, I am a big fan of office supplies, paper, pens, writing equipment. I have quite a few fountain pens, but the Lamy fountain pen is by far the smoothest writing, best drip experience. I think I'm going to write a few lines. I often write a few pages because Lamy just pushes the ink across the page, and it is wonderful. It's L-A-M-Y. Highly recommend. And the second is something I thought I would not like that has become my favorite pair of shoes. I got a pair of Italian leather shoes with a wooden base. There is nothing in the bottom of this shoe other than wood. And shockingly, it's the most comfortable pair of shoes I own. So hats off to Italian shoemakers.
Dr. Jerome Pagani: As a maximalist running shoe person, that surprises me a lot, but I love those answers.
Dr. Craig Joseph: I thought I was the only person in the world that was a fan of office supplies. So now I've met someone else. Well, that was great. Thank you so much, Dr. Baird. We learned a lot from you and wish you well as you go on to conquer readmission and care coordination. I look forward to seeing what you do next.
Dr. Tricia Baird: Craig, Jerome, it's been a pleasure. Thank you so much for taking the time.