Designing for Health: Interview with Zeev Neuwirth, MD [Podcast]

Artificial intelligence and other digital health technologies present enormous opportunities to transform healthcare delivery. They can lessen the load of menial day-to-day tasks, such as visit coding and charting, but also have the capability to tap into more advanced areas of care, freeing up time and allowing clinicians to focus more on patients’ holistic needs. As these advancements become ever-present, it’s critical to ensure that they enable and enhance human-centric care models to improve patient care and reduce burnout.

On today’s episode of In Network's Designing for Health podcast, Nordic Chief Medical Officer Craig Joseph, MD, talks with Zeev Neuwirth, MD, author of “Beyond the Walls” and “Reframing Healthcare: A roadmap for creating disruptive change.” He’s also the founder of the #HRL community and hosts the popular podcast series “Creating a new healthcare.” They discuss using AI and other technologies to humanize healthcare and the ongoing platform war. Dr. Neuwirth also offers his thoughts on the future of hospital at home.

Listen here:

Learn more about the #HRL community as well as Dr. Neuwirth’s books and podcasts at ZeevHealth.com.

In Network's Designing for Health podcast feature is available on all major podcasting platforms, including Apple Podcasts, Amazon Music, iHeart, Pandora, Spotify, and more. Search for 'In Network' and subscribe for updates on future episodes. Like what you hear? Leave a 5-star rating and write a review to help others find the podcast.

Want to learn more from Dr. Joseph? Order a copy of his book, Designing for Health.

Show Notes:

[00:00] Intros

[01:41] Dr. Neuwirth’s background

[09:50] How AI and digital health can humanize healthcare

[21:48] The ongoing platform war within healthcare

[25:08] ChenMed and how its clinician brainwashing is humanizing healthcare

[33:49] Hospital at home and its future

[36:49] The #HRL (humanistic rebel leader) community and its purpose

[42:26] Things that are so well designed, they bring Dr. Neuwirth joy

Transcript:

Dr. Craig Joseph: Zeev Neuwirth, welcome to the pod. How are you today?

Dr. Zeev Neuwirth: Great, thanks for having me on, Craig.

Dr. Craig Joseph: Well, I'm excited. I read your book, “Beyond the Walls,” and one of your books, I should say, the latest of your books. And I know you've been up to a lot. We're going to talk about #HRL a little as well. But before we get into all of that, I think it's fun just to kind of find out how you got to where you are. And so, can you give us a short summary, maybe under 45 or 50 minutes of a detailed description of your life? We like to start with kindergarten grades. What kind of grades did you get in kindergarten? All right, maybe not that much detail. But yeah, how'd you get to where you are?

Dr. Zeev Neuwirth: Yeah, correct. I'll make it closer to 45 seconds. So, I've been in healthcare for a long, long time. Started out as a primary care internist and terminal medicine doctor. And early on in my career, I really was shocked at how inhumane the healthcare system was, how dehumanizing it was to patients, their family members, and to doctors, nurses, and others in the healthcare system. I was really quite frustrated, even going back to my medical school days. And then in my residency program, of course, that's dehumanizing in and of itself. But really, just it was more about the care of the patient. When I became an attending, I spent the first, I would say a dozen years of my career really focused on how doctors and patients or in general in healthcare, how we were listening to each other and the issue of empathy. And then I realized it was even a bigger problem than that. And it was the fundamental approach, the fundamental, I would say business model of healthcare, payment, you know our focus on disease and illness rather than on health itself. And so, over the course of many years, I finally, you know, I was sort of going through my career, you know, again, I practiced in the hospital and in the ambulatory space for many, many years. I was in New York City, Manhattan. I was teaching in a residency program for internal medicine. Then we moved to Boston, and I worked there, I started to actually move into management and on the provider side and then executive roles to sort of chief transformation officer, chief redesign officer, chief medical officer, chief clinical executive. So, I was really kind of in the belly of the beast for many, many years. And then in 2014, literally a decade ago, two or three things happened in rapid succession that really sort of said, okay, you can't just keep on going on. You really have to go back to your roots and your core commitment, which is to really improving the healthcare system. Those three things briefly were my mother went into a hospital for a total hip replacement and didn't come out of the hospital alive due to a series of completely preventable mistakes. And despite the fact that I had spent at that point over two decades in healthcare, despite the fact that her other son had also spent over two decades in healthcare, and despite the fact that one of her daughters had also been in healthcare for nearly two decades, despite the fact that she had three kids who were all extremely engaged in healthcare and healthcare redesign, we couldn't save her. And I just could not wrap my head around that. And I couldn't forgive myself. And I couldn't forgive the healthcare system. And so that happened. And then within a year, I got a text from a colleague who informed me that one of my close colleagues, a physician, one of the best physicians I've ever met in my entire life, who was also a good friend of mine and a coworker and actually was my primary care doctor. He was that good. I actually had him as my primary care doctor. After seeing patients for a full week, he drove to a nearby park that's probably about a mile away from where I live, took out a gun from his glove compartment, and shot himself in the head. Even the people who had worked with him for decades never never saw this coming. And again, these two stories, my mother, that day that my mother passed away, let's just keep in mind that that day and every day there are somewhere between 500 to 1,000 families in the United States of America that go through the same exact thing, losing a loved one in our healthcare system from a completely preventable series of errors and mistakes and misguided focus, and the day my colleague shot himself in the head, at least one other doctor in the United States did that and does that every single day. And so, and again, look at the burnout rate in healthcare, it's over 60%. This isn't an anomaly. This isn't a minority. This isn't, by the way, about the people in healthcare care who are amazing. The people in healthcare are awesome. It's really the system that is really misguided. So, I decided I was going to start to look at an alternative way to go. And although I continue to stay in healthcare and in the hospital systems and on the provider side, I began to interview people who were what I call now humanistic rebel leaders, they were in healthcare. They were doing brilliantly something, they just said, I can't do this anymore. I have to actually make a difference. And I'm not just going to improve the system, I'm going to change it to make it a humane system, a respectful system, a system focused on actual health and wellness. And so, I began to interview these people. And I started that about nine years ago when no one, very few people were doing podcasts. I started a podcast, and which is now in its actually eighth year. I started interviewing with people probably a year and a half before that. And I would record these interviews, and I would transcribe them, and I would study them intensely. And out of that hundreds and hundreds of in-depth interviews and study, and of course reading about healthcare and informing myself, I got a master's in healthcare management from Harvard to really inform myself about the business side of healthcare. I began to formulate some ideas which turned into not only the podcast, which continues until this day, but turned into two books, “Reframing Healthcare” and “Beyond the Walls.” And, most recently turned into an online community that I just formed two weeks ago called #humanistic rebel leadership or #HRL.

Dr. Craig Joseph: And yeah, we're definitely going to talk about that. And I'm very interested in hearing more about what you envisioned for that. I would like, before we do that, just to talk a little bit about your latest book, “Beyond the Walls.” And certainly, your podcast is amazing. I've been a fan for a while, then I saw you speak at a conference, and I'm very excited about talking to you today. One thing that everyone's talking about nowadays is this thing called artificial intelligence. You might have heard of it, Zev. The American Medical Association wants to call it augmented intelligence. But under any circumstance, one of the ideas that you put forth in your book is that AI and digital health as well have the ability to rehumanize healthcare. And when I first read that, I read it in my in my brain as dehumanize healthcare. Right. Because that's what we hear more of that, well, AI is going to take care of, it's going to you know push the doctors and the humans out, and it's kind of dehumanizing. And you're seeing it as re-humanizing, which is a much more positive outlook. Why do you think that?

Dr. Zeev Neuwirth: That's a great question. So, it's funny, actually, I'm facilitating a panel next week at the HIMSS AI conference in Boston. So, this is timely. And it's called, the panel I'm leading and was invited to lead is called Taming the Wild Wild West of AI and Healthcare. So, here's the thing. In “Beyond the Walls,” as you know, I talk about three strategies: the digital tech enablement strategy, the business model transformation strategy, and the humanistic strategy. Now, the digital and business model transformation strategies are absolutely critical if we're going to advance healthcare. And this is not my hypothesis. This is, again, 10 years of intense research. The people that are transforming healthcare are using those two strategies, business model transformation and digital technology transformation, including AI. AI is absolutely going to be a game-changer. I don't think you can argue with that. We could talk about it. There's a lot of subtlety to it, but it's going to completely radically change the game in a way that I don't think anything has in the history of mankind, including healthcare. So, and again, there's pros and cons and dangers, but keep in mind when the telephone came out, people thought it was going to destroy the world. So, let's just keep those small things in mind. So, but the problem with it is this, if we allow digital technology and business transformation to lead us where we could head to, as we know, and again, we don't need machinery to enable the dehumanization of humanity or of healthcare, we do that well on our own. But if we let that be the leaders, either profit, or business model transformation, or digital technology. Technology is an enabler. It's not the strategy. It doesn't tell you the direction. We could very, very much end up going towards an even more dystopian future than we currently have today in healthcare. And it is dystopian currently. I mean, we could I'm happy to discuss that and go toe-to-toe with anyone if you want to talk about healthcare. It's dystopian. It's misguided. We could call it a lot worse than that. But imagine as the digital technology and AI comes into play and our business model transformations become even more powerful, if we are not led and we don't lead with a strategy of humanism, we are lost, we are done for. And so that's why that strategy is critical, and it took up the middle part of the book. And by humanism, I'm not talking about some sort of lofty philosophic ideals. I'm talking about very specifically eliminating racism, sexism, ageism, ableism, classism, and industrialism in our healthcare system. That's very, very specifically and I could give you examples. I mean, again, I'm not making this up. I didn't create this. I'm just looking at the people who are these humanistic rebel leaders who are really humanizing healthcare and what they're doing. They lead with humanism and they use digital technology and business model transformation as those two enablers. So that's really the core of it.

Dr. Craig Joseph: Yeah, I love it. I'm certainly not going to argue with you about the U.S. healthcare system. Having, you know, I've said on podcasts and speaking before that I'm not sure how normal people, and by that, I mean people who didn't go to medical school or nursing school. I have no idea how you survived that U.S. healthcare care system. And I've said that because I'm a consumer, I'm a patient, of course, and I can barely get through.

Dr. Zeev Neuwirth: The surgeon general, one of the previous surgeon generals under Trump, I'm blanking on his name for the moment. He wrote an article about this. He fainted while hiking, was taken to an emergency room, was given IV saline. He was hydrated and sent out, and he got a bill for something like $5,000, and that didn't include the ambulance bill. And he calls up the hospital, and he says, this is outrageous. I mean, it wasn't like you did any procedures on me. You just gave me some saline. And they were like, well, that's the cost. And they said, by the way, oh we forgot to add the ambulance bill to that. And he's sitting there, and he's frustrated on the phone for weeks and can't get anywhere. This is the ex-surgeon general of the United States of America. And finally, you know, he writes this article, and he has a high deductible health plan. So, for the first five or so thousand dollars, he has no insurance. That's what a high-deductible health plan essentially is. He has to pay for it out of pocket. And he's so frustrated. Now, again, can he afford it? Yes. But, you know, he's the ex-surgeon general in the United States of America. He's a physician. He's an executive. You know, he has money. But the vast majority of Americans don't have that kind of money. And all it takes is one emergency room visit or one hospitalization, and the majority of working Americans in this country will be in medical debt, and 50% of them will never, ever get out of medical debt. Now, that's the American healthcare system. I can go on and give you more facts and stats.

Dr. Craig Joseph: Yeah, all I want to talk about Dr. Neuwirth is a minor procedure that I just had that I knew required a prior auth because I'm smart and I'm in this business. I know how the game is played. And I talked to the doctor's office who was doing the procedure, and they said, oh, no, it's very odd. We called your insurance company, they told us it doesn't require one. And I knew that was garbage. I called my insurance company, and they're like, oh, you absolutely need one. Yeah, sure. And I almost had to cancel the procedure. Finally, they're like going back and forth. They're like, no, it doesn't need one. Guess what happened after the procedure? It was denied.

Dr. Zeev Neuwirth: Oh my God.

Dr. Craig Joseph: The payment was denied. We'll get it fixed. But why? Because it required a preauthorization. Right. And so again, I'm reinforcing your point of boy, even when you try, even when you know, and you have all the insights on how it's going to work …

Dr. Zeev Neuwirth: Craig, I just learned something which, again, I've been the senior medical director of population health for about four years and at a large hospital system. And this is a new one on me. So, the insurers, the insurance companies, you know all the deniers, the people who evaluate if a procedure or test is appropriate. So, the software programs and the doctors and the nurses in the insurance company that do all these things that are the deniers of care. Do you know where that cost gets charged? And I didn't know this. They actually consider that a quality activity, so those costs go right back into the medical loss ratio or the medical expense ratio. It's actually billed, it's put back into the cost of care, it’s considered a cost of care, it’s not even considered in the administrative cost of the insurers. I mean, did you ever know that? I've been in this for years. I was shocked to learn that.

Dr. Craig Joseph: Well, I did not know that. I guess I wouldn't be shocked though, because the argument for this is to prevent patients from having procedures or tests that are unnecessary and don't lead to anything.

Dr. Zeev Neuwirth: Right, unnecessary, yes.

Dr. Craig Joseph: Well, I love to complain, but I don't want to take up your time in complaining. However, if anyone listening wants to talk to me about it and hear me complain, just reach out and I'll be happy to do that. When I hear what you're saying about applying digital health and AI and to try to rehumanize, not dehumanize, I think one way you do that, or the major way I think is not looking for AI and then trying to, you know, we have this AI, we have this app, now we need to find a problem that it solves. You know, no, no, no, no. First, identify the problem and then see if there's an app or an AI that can solve it. And that seems to be the danger that, oh, we've got this AI, it's not doing anything.

Dr. Zeev Neuwirth: That's right. Well, yeah. No, and Craig, you know for those who are listening, let's make it very, very simple. If you're scratching your head and you're wondering how artificial intelligence or digital technology can humanize healthcare, you and I could give many, many examples. One that's very, very concrete, we know that primary care doctors spend what you know two, three hours a day doing charting and reviews and writing up their notes. And it cuts into their time and their ability. I mean, anyone who's seen a doctor and watching them, they're basically in the electronic health record typing and doing essentially what, high school level work, data entry and data retrieval most of their day. What if the machine did that for them? What if the machine was able to actually record the visit, chart, code the visit, write the visit up. I'm sure they could edit it and they will edit it. But if they did like 90% of the work, and we know that AI can actually do that just as well as a person, if not better. What if the machine could actually do, if the doctor has a question like, you know, is there a drug that is in trial, chemotherapy that's being trialed for this specific thing? The AI machine could come up with that answer in seconds, where it would take potentially hours for a doctor to find that out. I mean this is humanizing healthcare. It's very, very concrete. Humanizing it for the providers and humanizing it for the patients. I mean, who wouldn't want their doctors to be freed up from two hours of work every day so that they can actually spend their mind and their attention and their wisdom and their emotional energy on actually taking care of their patients rather than doing busy work and charting and coding and prior auths and all that. So, that's a very, very concrete example of how AI could humanize healthcare.

Dr. Craig Joseph: Yeah, I love it. And I think we're seeing that, right? We're seeing it actually happen. It's not science fiction. We're seeing microphones in exam rooms record the conversation and even queue up orders. Again, to your point, spending less and less time, you know, if I say I want to order a CBC to have that order there queued up for me for a quick review and for me to sign it. Again, the big difference is it's not automatically happening. It's just being queued up and lets me focus on looking at the patient, talking to the patient. One thing that is, I think, concerning to a lot of folks, is the kind of the downside of some of the digital health companies out there. You know, thousands and thousands of digital health companies come every year, are created, and that's great, we love that. The bad news is thousands of digital health companies are created every year. And you get frag, at least the worry is, and sometimes we see it, you get fragmentation of care, right? In the olden days, your only option if you had a healthcare concern was to see your primary care doctor. We didn't call them that, we called them my doctor. But that's who they were. And now I can go online, and I can get an app, and maybe there's an AI back there … What do you see as successful kind of thinkers contemplating this future?

Dr. Zeev Neuwirth: Yeah, there's no question you are identifying a very, very real problem in healthcare of thousands and thousands of point solutions, is what we call them, right? And you get these vendors barraging healthcare systems and provider groups with their specific solution set. I don't know. And this is an ongoing struggle. I don't know that I have a solution for it. I would say this is why executives, digital health officers, and chief medical informatics officers, and chief informatics officers, this is why they get paid the big bucks to try to figure out how to solve this problem. I do think that probably the solution is if I had to, if you know, said, okay, come on, give me an answer. I probably would say it lies in the notion of platforms. And so, the notion that we will probably have to have a platform, an overarching platform, and these solutions have to be embedded into it to make it seamless. And so, you see places like the Mayo Clinic with Dr. Halamka leading that effort where they're really trying to create a platform that which other technologies sit in and work in effortlessly. And again, the thing about platforms, and platforms is a whole other topic in and of itself. I've been studying this and talking about it and podcasting about platforms for a couple of years now. And there's a lot of good resources out there in terms of platform development and in healthcare. I do think that you have to understand also, it's almost kind of like that Russian doll thing. There's platforms within platforms. So I actually think, and I think I said this in “Beyond the Walls,” I think there's a platform war going on right now in healthcare. Who is actually going to be the platform? Is it going to be Amazon? Is it going to be Google? Is it going to be the Mayo Clinic? Is it going to be one of the electronic medical records? Is it going to be another company that we don't even know about yet, some data analytics company? I don't know what the platform's going to be, but I do think that's where we are today. It's going to get solved. I think it'll be resolved. It'll shake itself down. You know you can't have a market with so many digital solutions. The winners will begin to surface. I mean if you look at other industries, it's not dissimilar from other industries where typically you end up with two or three major solutions coming out. Again, you think about Amazon, you think about Google and Microsoft, you think about Apple, it'll shake itself out. There'll probably be a small number of very, very large platforms where they will figure out how to stitch all this together.

Dr. Craig Joseph: You've stolen one of my questions, so good. Now we understand what platforms are. And I was hoping you were gonna tell us who it was gonna be so I could invest.

Dr. Zeev Neuwirth: I don't know.

Dr. Craig Joseph: All right, all right. Well, I'll move on then. I'm just gonna have to do my own work now, it seems.

Dr. Zeev Neuwirth: I'm sorry, Craig.

Dr. Craig Joseph: I appreciate that. I was fascinated by one of your interviews with Chris Chen, who's one of the co-founders of ChenMed. And they do many things. They have kind of a concierge-like senior care organization. But one of the things that you mentioned, which I was just thought, wow, that's out there, onboarding of new physicians. I think that Dr. Chen actually said, it's a brainwashing, quote, unquote, air quotes, brainwashing course that lasts up to six months. And so, can you tell us a little bit more about what are they doing in brainwashing their physicians? Is that good? Should we all be brainwashed a little bit?

Dr. Zeev Neuwirth: Yeah. Actually, Craig, he describes, and his brother Gordon describe sort of a debrainwashing or deculting of physicians that they hire. So, we have all been brainwashed to think a certain way about healthcare. It's highly transactional. It's widget-based. I want you to understand this, I have tremendous respect for, I mean, tremendous respect for physicians and APPs and nurses and other clinicians in healthcare and techs and staff. I can't tell you how much I respect the people in healthcare. I'm in awe of them. My wife's a doctor, my brother's a doctor, my best friends are doctors and nurses. So, I mean, I just want to say that at the start. But here's the story. We have become visit vendors. I mean, if you think about the healthcare industry, we are nothing but visit vendors. I mean, you have a bunch of visits, and you sell your visits, and then you try to, you know, code your visits, upcode your visits to try to wring out as much revenue as you can from your visits. You add some ancillary service to those visits that you're bending. We're visit vendors. If you're a specialist, you're a visit vendor. If you do procedures, you have a procedural visit that you've been, you know, if you have hospitals, you have slots that you're selling too. I mean, that's what we do. And you know it is a certain type of mindset that we've been acculturated to. It is so insidious that we don't even know that we've been acculturated to think a certain way, to do things in a certain way. We're part of a much larger, and I'm not making this term up, but a much larger industrial complex, you know pharmaceutical, medical, industrial complex. We're part of that machinery. We're just another cog in the wheel, you know dispensing medications that pharma makes, dispensing medical devices that the medical device industry makes, dispensing working on the insurance and the payment that the insurance company makes. You know, again, it is what it is. There's a lot of good to it. So again, let me be clear. I am very grateful that we have the healthcare system that we have for many, many things. I think we're all very grateful. And the science and technology and the wizardry and the people in it. I mean, I can't say enough about all of them and what we're doing at the same time. We've been brainwashed to do a certain thing, which is, I would say, saying it very, very kindly. It's misguided. And again, we can talk about the facts of why it's misguided. Like, for instance, despite the fact that we spend more money than any other healthcare system, by far, our lifespan is decreasing in the United States of America. We're the only developed nation year over year where we're dying younger and younger. And by the way, the dirty, little secret in there, which is so upsetting, the dirty little secret is that a small percentage of us are living longer and a lot of us are dying younger. The difference in every great city in this country, the difference between the wealthiest zip code and the poorest zip code in terms of lifespan could be 15 to 30 years. We're literally building third-world countries right into our greatest cities in this country. So, we could go on and on. But, you know, I think that, like I said, tremendous respect for the system, but it is misguided. What Chris does and ChenMed has done, they say, listen, we want you to forget all that you learned. You're not a visit vendor anymore. We're going to give you a few hundred patients to take care of. We don't even want you to think of them as patients. We want you to think of them as your family members, okay? And you're going to do for them, we're going to pay you, we're going to pay you well, but we want you to treat them like you would treat your family members. So that means literally they have your phone number, okay? It's not that they're going to call some phone tree. Press three if you're dying. Press four if you want to go to the ED. You know, that's not the way it works at ChenMed. You're gonna, and this is the radical, radical thing. And you listen to that interview. Their whole mission is summed up in one word. It's called love. And he is unabashedly, I mean, they're not embarrassed about that. They say we want physicians and nurses and MAs that literally will love our patients. And we built a whole system around loving our patients. When COVID happened, you know what they did? They gave every doctor a stipend and they said, we want you to use this to show your patients how much you love them. And doctors were going out and buying food and buying groceries and buying flowers and literally with masks on going into people's homes into their apartments in the inner city and handing them these things and saying, I want you to know we're thinking about you. We know you're lonely. They were calling up their patients and taking care of them. I mean, this is what they did. And so, it's not a brainwashing. It's an unbrainwashing of a highly dehumanizing system for everyone involved.

Dr. Craig Joseph: Yeah, and they make money. I think that's one of the problems, right? That the reason we've become, so a lot of the reasons that we've become where we've gotten to where we are, is because of the payment model.

Dr. Zeev Neuwirth: And Craig, they, you know, they're a great example of the beyond the wall strategy I was talking about before. They're driven by unbelievable. I mean, every time you could look them up, you could read their books, you know, you could go listen to the podcast I've done with Chris, they're driven by humanism, but they also have state-of-the-art technology. They have their own, as far as I know, they're the only provider group I know, they have their own Digitech company. I mean, they have a mid-sized digital tech company that is separate from the provider group that builds all of their technology and all of their analytics, all of their predictive analytics, all of their evidence-based medicine modules. It's all, they’re state-of-the-art digital. And of course, as you just pointed out, their business model is not visit-bending. They don't bend visit. They actually have a capitated model, so they get paid a certain amount each month per member, and that allows them to really invest in a humanistic healthcare. And again, they were the first group, they may be the only group, when they shut their practices down at five o'clock and stop seeing patients, they open up their waiting rooms and their halls and create social halls where they actually invite patients, and they have minibuses as part of their tenants. They transport patients in the evenings, because they know older, sicker patients may be alone and lonely, and they know that relationships are actually not just nice, they're actually critical to wellness and to life itself. And there's a strong evidence now that shows that loneliness, as you know, and actually the surgeon general wrote a book about this, that loneliness is as harmful to you as smoking half a pack of cigarettes a day. So, they knew this years ago before the evidence, and they were treating their patients like people and literally creating social halls out of their waiting rooms in the evenings and weekends. That's not brainwashing. That is humanizing healthcare and humanizing the system. But in order to do that, to your point, they have to get people thinking very, very differently about healthcare.

Dr. Craig Joseph: Yeah, no, absolutely. Pivoting just a little bit, I love the concept of a visit vendor, because it does kind of in two words just encapsulate where people are. There's a quote in your book from Raphael Rakowski, who's the founder of Clinically Home, which allows hospitalization at home. And the quote is, hospitals were essentially built on the factory model. And they're kind of like factories. That seems to kind of resonate with this, on the outpatient side, a visit vendor. It's the same sort of thing. What do you see as kind of coming with the concept of hospital at home? It picked up a little bit because people would pay for it during the pandemic. Is it going to stay? And if so, how does it work?

Dr. Zeev Neuwirth: Yeah, again, I really don't like to make predictions. It actually was Raphael and it's medically home. You know, I think, no, it's okay. It would be hard. So here we have a solution or alternative to hospitalizing patients where they get to stay in their own home, they get state-of-the-art medical care and technology and monitoring with a group of people who are watching them very, very closely, monitoring them 24-7 very closely. We know from the literature, at least as far as I know, from the research literature so far to date, that it reduces the costs dramatically. But more to the point, the literature tells us that there are less falls, there's less delirium, there's less clinical errors, there's lower readmissions into the hospital, and actually, most importantly, mortality decreases if you do a hospital at home. And we know at this point in time, probably somewhere between 40 to 60% of the visits that go into the brick-and-mortar hospitals can be transitioned safely into hospital at home or diverted into a hospital at home. So, when you take something that actually is safer, and less costly, and reduces deaths, and then you ask the question, do you think we're going to head in that direction? My answer would be, I hope so. I hope so. In terms of the actual industry of hospital at home, I think it's still going pretty strong, although you're right. It obviously burst onto the scene during the pandemic, and then there was a bit of recidivism. But I think from everything I see, I think that that is going to continue to grow. Actually, I think it's quite, I think the competition in that field is actually quite rigorous, which is a great thing. It shows it's a healthy market, so I think it's going to continue to grow.

Dr. Craig Joseph: Awesome. So, you did make a prediction. See, even though you don't like to do it, you did it.

Dr. Zeev Neuwirth: No, you got me, you tricked me, Craig, you got me to make a prediction.

Dr. Craig Joseph: It's on a tape of some sort. They tell me it's digital now. I don't understand that. So, all of this is kind of all of your research and your clinical experience and your personal experience has kind of been pushing you in towards this direction of what you're working on what you just announced a few weeks ago. Hashtag HRL. So, let's hear more about that. What are you doing? And how do you think it's going to help?

Dr. Zeev Neuwirth: Yeah, what I've really come to realize, particularly over the past years I've been talking to people, going out and giving talks and lectures and retreats and seminars on beyond the walls, and the one thing I hear over and over again is after, you know, and this comes from physicians, executives, it's even CEOs. It's like, but Zeev, what can I do? I'm just I'm just a doctor. I'm just an executive. I'm just a nurse. I'm just a CEO. What can I do? And I argued with this perspective for a year. And then I realized not that long ago that they were right. They can't do anything. Individuals by themselves cannot really change an industry, can't change a system. I can't, but we can. And if you look at the history of transformation and take the forming of you know of our country, the United States of America, that wasn't one individual. That was a community, a network of individuals who came from a diverse background. They didn't even love each other. But together as a network, as a community, they created the greatest nation in the history of mankind. And yes, it was messy, and it was difficult, and it was challenging, and there was sacrifice, and there was commitment, but it was the network effect. It was the community effect. And we see that over and over and over again. And so, I began to realize that these individuals, these humanistic rebel leaders needed to come together. And I kept on hearing from individuals how frustrating it was, how lonely it was. I really have heard that even up to this week, I was talking to someone and it was just like, I'm all by myself trying to change the system. And so, I said, let's not try to do it by ourselves. Let's get together. So, I recently formed an online community. It's a membership. It's called hashtag HRL. As you said, in fact, here it is. I'm wearing the logo, and it stands for humanistic rebel leadership. And I'm really looking for people like myself, I would say like you, Craig, who are really interested in humanizing healthcare, who are committed to it, who have either dedicated or want to dedicate their careers andtheir professional passion to it. And instead of doing it alone, let's do it together. You know, very concretely, I was talking to a young physician who's also an entrepreneur and she's got some great ideas, and she's reaching out to me, and she's saying, Zeev, could I tell you about my idea? I said, yeah, of course I'm going to listen to you, doctor, but I said, I got a better idea. We have a community, an online community, of now over 50 people. It's going to be thousands and thousands of people over the next few months. Could you imagine if you went on there right now and you started talking about what you're doing, I guarantee you there are dozens of other people who would flock to you and say, hey, doctor, I've got an idea. I've got something that can help you. Or I want to join you and partner with you. Or I want to work with you or for you. That's the kind of collaboration, that's the kind of partnership I'm looking for. In fact, that happened twice this week to me. When I was talking to someone, I said, I'm happy to listen to you, but there's already 50 people that I guarantee you there's at least two or three or five or 10 that are really interested. And I bet two or three of them can actually help you quite a bit. And that's the idea behind him behind the hashtag HRL. It's not for everyone. It's not for everyone. If you if you are fine with the healthcare system the way it is, if you are fine with incremental improvement, this is not for you. This is for people who really want to humanize healthcare in our lifetime. It's really simple. I'm not trying to over-engineer it. We have sort of collections on it. So, if you're interested in it, I was just talking to someone who's interested in care coordination. I said, you could go on and lead a whole little collection of people just on care coordination. Or if you want burnout or resilience, you could do that. Someone was interested in substance abuse, or if you want hospital at home. So, that's the idea it's called hashtag HRL. And all you have to do is go to my website and it'll click right onto that one. And my website is zeevhealth.com, it’s the easiest way to get there.

Dr. Craig Joseph: All right, well, that is super interesting. And I think it's exciting, you've just started it. So already you're you've got some you've got some leverage, we will include that link in our show notes in case anyone missed it, as well as a reference to your book “Beyond the Walls” so that they can find it, and also, I don't like to acknowledge that there are competing podcasts, and by competing podcasts, I mean any other podcast. However, because in my world, there's only one, and it's this one that you're listening to right now. But we'll put a link in the show notes to your podcast, which is excellent. Excellent. I can't say enough good things. It's been a pleasure, Zeev, one of the things we like to do at the end of all of our conversations is ask about design. And we've been talking about intentionality and design. We haven't really used those words, but that's what we've been talking about, kind of thinking through things before we do them. Is there anything in your life that you think is so well-designed that it brings you joy?

Dr. Zeev Neuwirth: Well, you didn't give me a lot of lead time to think about this, but I'll tell you my first gut reaction. I mean, the most well-designed thing I've encountered is my family. I don't know how to describe it. Having a spouse, having a life partner, and then having children, it's by far the most well-designed thing that I have come across. I know it wasn't designed by the hand of man, but that's my first thought that comes to mind.

Dr. Craig Joseph: Dr. Neuwirth, I think we're on to something here. I think we need to give you less time to prepare more frequently. That's a great answer, and I love it. So, I will accept that answer. You're lucky, because if I didn't, you'd have to come up with something else. It's been a great pleasure talking to you, and I certainly wish you success on all of those endeavors, and I hope that our listeners are interested enough to interact with you in either the podcast or the book or through the community hashtag HRL. Thank you again.

Dr. Zeev Neuwirth: Craig thank you for having me on, thank you.