Tag Archives: PopHealth Week

An Interview with Dr. David Shulkin and a Review of His Book

I recently had the good fortune to interview Dr. David Shulkin, the ninth Secretary of the Veterans Administration on PopHealth Week regarding his book “It Shouldn’t Be This Hard to Serve Your Country: Our Broken Government and the Plight of Veterans”. What a story! He goes through the unique interview/non interview he had with then President elect Trump, where he was not sure if he was interviewed, if he was offered a job or not and then to learn about his appointment via the the media.

One of the big surprises for me was learning that certain Veteran’s groups, in particular Concerned Veterans of America is really a Koch brothers funded organization which is pushing hard for the complete privatization of the VA. This group created trouble throughout his time as VA Secretary. The problem I have with complete privatization is that there are unique issues that Veterans face, that are much different than the general population, Medicare or Medicaid. Things such as traumatic brain injury, spinal cord injury, blind rehab, hearing issues, PTSD, prosthetics and orthotics, poly trauma and environmental hazards of war; for which there is little to no expertise to treat these in the private sector. These are areas in which the VA has developed expertise through years or research and experience. Dr. Shulkin clearly articulated that the VA serves a unique role, that the Veterans deserve top notch services, and that a hybrid public/private system is appropriate. But that you can’t just push Veterans into an unprepared or inappropriate private sector service.

He also proposed an interesting idea for changing the VA structure. His approach would make it unlike other departments by removing the political appointees and making the Secretary a four year appointment, in a model similar to the Federal Reserve.  This idea seems to make sense given the VA’s unique mission and what should be a Veteran centric versus political approach.  At the same time, Veterans need to have a voice and how one assures their voice is heard through the very political process in Congress is important.   I fear it might create pressure on Congress via heavy handed lobbying groups seeking to regulate the purse strings, although that goes on now.

During his tenure he worked on a number of important issues including wait times, the opioid crisis and Hepatitis C, among others. In each of these cases he had the VA put in a systematic and measurement based approach to improve these issues with an excellent example being Hepatitis C where they essentially worked to treat everyone, something we could learn from in the Private sector.

One thing that is I found bothersome was Dr. Shulkin’s belief that the President was unaware of what his political appointees were doing. I just kept thinking to myself “Why do you continue to separate in your mind the President and for example his Chief of Staff from the political appointees, using terms like “While largely unaware of the political appointees’ scheming…”. I cannot fathom that the President was truly unaware of what was going on, or that this was not all part of the plan. But Dr. Shulkin still believes that the President was unaware of these things. Now what that says, positive or negative about the President is clearly up for debate. But assuming as President Truman said “The Buck stops here”, as a former CEO, I fall on the side that, “being unaware” is a failing.

My recommendation to you, It Shouldn’t Be This Hard to Serve Your Country: Our Broken Government and the Plight of Veteran is a great read, both from a healthcare and political perspective. The unique insights it provides into the VA, their issues and President Trump and his administration are deep and important to understand. There’s much more that I did not cover in this post, including the major ethical issue Dr. Shulkin faced regarding his trip to Europe and the Wimbledon Tennis match, what it really was, and how it was used in the end to remove him. But you’ll have to read the book to get those.

After our interview, Dr. Shulkin said he’d be happy to come back on and discuss more about his experiences, thoughts, and the book. I hope to take him up on that offer.

Click below to listen to the show.

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Announcing PopHealth Minute

I recently launched a new feature in conjunction with HealthCareNow Radio. Its called PopHealth Minute. These are one minute quick dives into issues, ideas and thoughts in Population Health. HealthCareNow Radio plays these episodes between shows, but you can access them anytime. Click on the image below to see the diversity of issues covered and listen to PopHealth Minute…

If there is a topic you’d like to hear covered, send me a note and I’ll attribute the topic request to you in the episode.

Thanks also to my son Scott Goldstein for the graphics associated with PopHealth Minute and PopHealth Week.

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PopHealth Week: New Look, New Syndication Times

Gregg Masters and I recently updated PopHealth Week to include a new look and new syndication times with HealthCareNow Radio. The weekly show still features the same great guests exploring all things population health and now you can listen to it syndicated on HealthCareNow Radio at 5:30 am, 1:30 pm and 9:30 pm Eastern Time.  Take a look, here’s the new logo:


PopHealth Week Banner Asset 15 (2)@3000px

You can follow @PopHealthWeek on twitter and look for the show tweet so you’ll know who’s on. Here’s an example:

Dr. Steve J. Schienman

And if you can’t listen to the broadcast on HealthcareNow Radio,  you can catch prior episodes anytime you’d like right here.

Thanks for reading and I hope you’ll tune in to PopHealth Week.

Coming up soon another fun project… PopHealth Minute.


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Meet Archelle Georgiou, MD on PopHealth Week

On PopHealth Week, Wednesday, May 1st, 2019 our special guest was author of Healthcare Choices: 5 Steps To getting the Medical Care You Want & NeedArchelle Georgiou, MD.

‘Dr. Archelle Georgiou is a nationally recognized physician, advocate, advisor and Archelleauthor. She earned her medical degree from the Johns Hopkins School of Medicine and enjoyed practicing internal medicine in Northern California. However, wanting to have a broader impact on the healthcare system, she shifted her focus to the managed care industry. Between 1995 and 2007, she was a senior executive and Chief Medical Officer of UnitedHealthcare where she dismantled many of the company’s legacy policies in order to minimize the bureaucratic burdens imposed on patients and physicians.’

‘Since 2008, Archelle has served as a senior advisor for a diverse group of companies serving health needs in industries ranging from education to analytics and financial services to mining. She worked with former Speaker of the U.S. House of Representatives Newt Gingrich at his Center for Health Transformation, a non-partisan think tank focused on advancing patient-centric sustainable healthcare policies.’ 

Click below to listen to the show:


Archelle Georgiou, MD on PopHealth Week


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H.R. 7038 has been Reintroduced as H.R. 660 The CHILD Act – Incenting Communities to Improve the Health of Their Medicaid Beneficiaries

I’m updating this post to let you know that the bill has been reintroduced as H.R. 660 in the 116th session of Congress.  The new link to the bill is here.  We are looking for sponsors and support.


This past week on PopHealth Week Gregg and I discussed the Annual Medicare Wellness Visit and how it came to be.  I have always dabbled in policy and was fortunate enough to participate in the creation of that piece of legislation.

More recently,  a small group including Reyn Archer, MD, the former Commissioner of Health for the State of Texas and current Chief of Staff to Congressman Jeff Fortenberry, Doug Goldstein and I have been exploring ideas on community health improvement. One of the key gaps we identified was that if a person or community works to improve their health, the financial benefit accrues to the payer or providers. At the same time, sustainable financing has been a fundamental problem with many of the community health improvement initiatives, such as Blue Zones, The Way to Wellville, the Clinton Health Matters Initiative, Humana’s Bold Goal initiative, which typically have the funds to get started, but after a few years have no source of revenue to continue. We sought to solve these two issues.

While I have been working on a concept I call Havens of Health, a Medicare /Medicaid  Health Plan owned by its members;  Reyn had come up with the concept of creating Community Shared Savings Accounts as the vehicle to distribute/share funds and provide incentives.

For the past three years we have been working on legislation to do just that, and I am excited to announce that we now have a Bill, H.R. 7038 the “Community Health Improvement, Leadership, and Development Act of 2018” or the “CHILD” Act.   The purpose of the bill is:

To give communities the tools to improve their own health outcomes through community-relevant health information and new health supporting incentives and programs funded without further appropriations.

The idea is simple:

  • it tasks HHS/CMS with putting together data sets of relevant Medicaid epidemiological and claims health information,
  • provides grants to states to carry out localized Community Health Improvement programs which includes the creation of dashboards for the community
  • The Community puts together a program to target one or more of these conditions and
  • if the program reduces the rates of illness in the  community’s Medicaid beneficiaries and/or lowers costs, 70% of the savings would go back to the community.
  • These savings would be placed in the Community Savings Account to be overseen by a local board, and “used for promoting the health and wellness of residents of the community.”

This bill has bipartisan support, being co-sponsored by Congressman Jeff Fortenberry (R) and Congresswoman Eddie Bernice Johnson (D), and establishes an incentive for communities to work to improve the health of their residents while also creating a sustainable source of funding for communities to begin to work together on both the clinical and social determinants of health, as some have been doing for a while.

If you’d like more information on H.R. 7038 please contact me.

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