Hello and welcome to Prophets Healthcare Changemakers podcast, where we'll be talking to leaders in healthcare who are focused on transforming their organizations to drive the next level of growth for their business and for healthcare at profit. We believe that the organizations that thrive in healthcare are those that dare to change the game, striving to improve human health, create better experiences and make the best of care and enduring and sustainable reality for all. Those that will transform health care are the changemakers. And for this podcast we want to focus on them. Our podcast dials into and recognizes the people behind the transformation and their journeys and changing the game one story at a time. Are you ready to dive in?

Hello and welcome to Prophets Healthcare Changemakers podcast, where we'll be talking to leaders in healthcare who are focused on transforming their organizations to drive the next level of growth for their business and for healthcare at profit. We believe that the organizations that thrive in healthcare are those that dare to change the game, striving to improve human health, create better experiences and make the best of care and enduring and sustainable reality for all. Those that will transform health care are the changemakers. And for this podcast we want to focus on them. Our podcast dials into and recognizes the people behind the transformation and their journeys and changing the game one story at a time. Are you ready to dive in?

All right. This is Jeff Gorgie here with the Profit Health Care Changemakers podcast. I'll be hosting this week's conversation, and I'm very pleased to have with us David Grandy. David, welcome to the podcast.

All right. This is Jeff Gorgie here with the Profit Health Care Changemakers podcast. I'll be hosting this week's conversation, and I'm very pleased to have with us David Grandy. David, welcome to the podcast.

Thanks, Jeff. Great to be here.

Thanks, Jeff. Great to be here.

So, David, tell us a little bit about yourself and take us back to your career path and what led you to where you are, and then we'll get into your current role next. But take us back to where you've come from and where you've gotten to now and give us one fun fact that maybe is on your Facebook page, but not your LinkedIn page or maybe isn't on social media at all if you're willing to share.

So, David, tell us a little bit about yourself and take us back to your career path and what led you to where you are, and then we'll get into your current role next. But take us back to where you've come from and where you've gotten to now and give us one fun fact that maybe is on your Facebook page, but not your LinkedIn page or maybe isn't on social media at all if you're willing to share.

So my career in healthcare started a couple decades ago. Now, my first job out of college, I was the intern for the chief medical officer of a multi hospital health system, and it was a fascinating view of a lot of layers of an organization. I think both the sort of executive leadership layer as well as the physician relations layer as.

So my career in healthcare started a couple decades ago. Now, my first job out of college, I was the intern for the chief medical officer of a multi hospital health system, and it was a fascinating view of a lot of layers of an organization. I think both the sort of executive leadership layer as well as the physician relations layer as.

You do, you always know you wanted to work in health care. How did you start there?

You do, you always know you wanted to work in health care. How did you start there?

It did. From the time I was very young, I actually had some health issues, some pretty serious health issues when I was a younger adult. And so I was exposed to hospital life. And it was fascinating to me, despite all the things that I was going through personally, it was just interesting to me how all the different parts and pieces and disciplines came together. And so I think I knew from a pretty young age that I wanted to go into a helping profession. And medicine initially was where I thought I was was headed.

It did. From the time I was very young, I actually had some health issues, some pretty serious health issues when I was a younger adult. And so I was exposed to hospital life. And it was fascinating to me, despite all the things that I was going through personally, it was just interesting to me how all the different parts and pieces and disciplines came together. And so I think I knew from a pretty young age that I wanted to go into a helping profession. And medicine initially was where I thought I was was headed.

So to ask, did you think about what med school did?

So to ask, did you think about what med school did?

I did I actually one of my undergrad minors was in biomedical sciences, so I checked all the boxes to go to medical school, took the Mcat and ultimately decided against in part because at that time. Physicians were very unhappy people. And so in my day to day internship, this is what I heard over and over again. You have to really want to get into something that you'll devote your life to and go into an amazing amount of debt and come out of that on the other side and maybe not be happy. So it was a pretty strong disincentive for me. Yeah. So that was sort of my initial foray into the, the sort of traditional side of healthcare. And I decided that that was going to be my life's work in a lot of respect at the time. You know, when I looked around the table, there weren't many young people who were going into healthcare administration. The route was often you were a clinician of some kind and were a really great clinician, and you got promoted into a management position and you went on from there were very few that sort of had leadership as their focus. And so I thought this could be interesting. And I went on with the same system for about a decade. I did a lot of work in operations and strategy and ended up running a variety of clinical and non-clinical ops as part of that system. This particular health system was interesting in the fact that now, 20 some odd years ago they hired a chief innovation officer. They may have been one of the first health systems in North America to do so. Pretty progressive CEO at the time. This was a gentleman that came out of the Silicon Valley. His focus was largely on business model innovation and really helped the system to structure in a very matrixed way service lines, which were the strategy and innovation arm of the organization, and then hospitals which were the operating arm. So I had this interesting role where I was working in operations, looked at this innovation group and raised my hand and say, Hey, I want to be a part of that. That looks like something interesting. My brain kind of works in that way, and so made some promises that, you know, I would work nights and weekends to be part of this group, but was then exposed to very different ways of thinking and learning and developing ideas, innovations that would stick and ultimately move from strategy into operations, sort of uniquely positioned to see both ends of it. And I think a light bulb went off. Me at that point in my career, I said, this is this is really where I belong. It's where my healthcare innovation is. Yeah, I have something maybe unique to contribute here. I've made that my life's work.

I did I actually one of my undergrad minors was in biomedical sciences, so I checked all the boxes to go to medical school, took the Mcat and ultimately decided against in part because at that time. Physicians were very unhappy people. And so in my day to day internship, this is what I heard over and over again. You have to really want to get into something that you'll devote your life to and go into an amazing amount of debt and come out of that on the other side and maybe not be happy. So it was a pretty strong disincentive for me. Yeah. So that was sort of my initial foray into the, the sort of traditional side of healthcare. And I decided that that was going to be my life's work in a lot of respect at the time. You know, when I looked around the table, there weren't many young people who were going into healthcare administration. The route was often you were a clinician of some kind and were a really great clinician, and you got promoted into a management position and you went on from there were very few that sort of had leadership as their focus. And so I thought this could be interesting. And I went on with the same system for about a decade. I did a lot of work in operations and strategy and ended up running a variety of clinical and non-clinical ops as part of that system. This particular health system was interesting in the fact that now, 20 some odd years ago they hired a chief innovation officer. They may have been one of the first health systems in North America to do so. Pretty progressive CEO at the time. This was a gentleman that came out of the Silicon Valley. His focus was largely on business model innovation and really helped the system to structure in a very matrixed way service lines, which were the strategy and innovation arm of the organization, and then hospitals which were the operating arm. So I had this interesting role where I was working in operations, looked at this innovation group and raised my hand and say, Hey, I want to be a part of that. That looks like something interesting. My brain kind of works in that way, and so made some promises that, you know, I would work nights and weekends to be part of this group, but was then exposed to very different ways of thinking and learning and developing ideas, innovations that would stick and ultimately move from strategy into operations, sort of uniquely positioned to see both ends of it. And I think a light bulb went off. Me at that point in my career, I said, this is this is really where I belong. It's where my healthcare innovation is. Yeah, I have something maybe unique to contribute here. I've made that my life's work.

I'm not going to let you off the hook on the fun personal tidbit, and we'll pivot to Kaiser Permanente.

I'm not going to let you off the hook on the fun personal tidbit, and we'll pivot to Kaiser Permanente.

Roller coasters. I am a roller coaster junkie. In fact, I have been on roller coasters on several continents. Often when I go to a new place, a new destination for travel, I will seek out a theme park and look for the biggest, baddest roller coaster, Cedar Point in Sandusky, Ohio. The roller coaster Mecca of North America is a place I have spent hundreds and hundreds of hours. I love them. All right.

Roller coasters. I am a roller coaster junkie. In fact, I have been on roller coasters on several continents. Often when I go to a new place, a new destination for travel, I will seek out a theme park and look for the biggest, baddest roller coaster, Cedar Point in Sandusky, Ohio. The roller coaster Mecca of North America is a place I have spent hundreds and hundreds of hours. I love them. All right.

Well, that is a fun fact. Okay. So your consulting role led you to working with Kaiser Permanente as a consultant. Tell us about that and how that kind of, I assume, directly led you into this opportunity that you've taken now.

Well, that is a fun fact. Okay. So your consulting role led you to working with Kaiser Permanente as a consultant. Tell us about that and how that kind of, I assume, directly led you into this opportunity that you've taken now.

Yeah, no, that's exactly right. So Kaiser Permanente had at one point in time put out a design challenge, and it was called the Small Hospital Big Idea competition. And it was effectively an open source design competition to reimagine the inpatient facility. And it was wildly successful. On the heels of that, they decided that they wanted to do something similar for their ambulatory facilities. That's how things were, at least initially, defined. What is the mob of the future? And so they invited a small number of firms, so quasi open source to compete again around some very specific innovation challenges. And my team and my firm were fortunate enough to win that competition. And so that was my first introduction to KP. And as we got into that work that went on for many years with the organization, and eventually they said, Why don't you come in-house and build something here? And it's been that ever since.

Yeah, no, that's exactly right. So Kaiser Permanente had at one point in time put out a design challenge, and it was called the Small Hospital Big Idea competition. And it was effectively an open source design competition to reimagine the inpatient facility. And it was wildly successful. On the heels of that, they decided that they wanted to do something similar for their ambulatory facilities. That's how things were, at least initially, defined. What is the mob of the future? And so they invited a small number of firms, so quasi open source to compete again around some very specific innovation challenges. And my team and my firm were fortunate enough to win that competition. And so that was my first introduction to KP. And as we got into that work that went on for many years with the organization, and eventually they said, Why don't you come in-house and build something here? And it's been that ever since.

That's great. Well, okay, so let's pivot. Let's pivot to your change agenda. As vice president of innovation at Kaiser Permanente, tell us about the kind of human problems you're solving, whether they're consumer experience problems or physician workflow problems or whatever the case may be?

That's great. Well, okay, so let's pivot. Let's pivot to your change agenda. As vice president of innovation at Kaiser Permanente, tell us about the kind of human problems you're solving, whether they're consumer experience problems or physician workflow problems or whatever the case may be?

Yeah, it's really all of those things. You know, our broad mandate is what we call delivery system modernization. And that isn't to imply that what we have isn't modern and forward leaning, but it's it's simply a North Star, if you will, for us to dig in to opportunity, where are the places where our members, our providers run into dead ends, where the experience for them isn't optimal, where there are pain points. Alternatively it's where is there latent value that exists in the marketplace? Are there areas that Kaiser Permanente should be looking at that we maybe haven't looked historically that could add value to our business? So those broadly are the things that we help the organization look at its delivery system, modernization and how do we create really new forms of value in service of those different constituents?

Yeah, it's really all of those things. You know, our broad mandate is what we call delivery system modernization. And that isn't to imply that what we have isn't modern and forward leaning, but it's it's simply a North Star, if you will, for us to dig in to opportunity, where are the places where our members, our providers run into dead ends, where the experience for them isn't optimal, where there are pain points. Alternatively it's where is there latent value that exists in the marketplace? Are there areas that Kaiser Permanente should be looking at that we maybe haven't looked historically that could add value to our business? So those broadly are the things that we help the organization look at its delivery system, modernization and how do we create really new forms of value in service of those different constituents?

Are there 1 or 2 that are either public or close to becoming public or that you can kind of hone in and tell us about the specific challenge, how you're tackling and what we're going to see. And again, not sure what you can share, but I'd love to know what you can.

Are there 1 or 2 that are either public or close to becoming public or that you can kind of hone in and tell us about the specific challenge, how you're tackling and what we're going to see. And again, not sure what you can share, but I'd love to know what you can.

Well, as you can imagine, a lot of the work that we do is held pretty tightly to the vest because our charge, again, under that sort of umbrella of delivery system modernization, is to help the organization think about where it goes next. If you think about a strategic plan, our work may be 3 to 5 years out from that plan, right? Testing, looking at opportunities, working future or market back. How do we solve human need business needs simultaneously kind of testing core assumptions around some of those possibilities and ultimately whittling them down to 1 or 2 solutions which in a couple of years become core to the business. So that's a general answer. I'll say. I think part of what we and many organizations are looking at now broadly is how do we really effectively take care of populations? How do we extend evidence based care and population health to more people in more places? The benefit, of course, of Kaiser Permanente historically is that our business model had these has these really well aligned incentives, right? We're a payer and we're a provider. And so we are incentivized to do things that others are not like to invest in prevention and screening and and so forth. When you get out of that sort of integrated or closed model into a multi. Payer environment, things become instantly more complex. And so if we want to extend our influence, we've got to think about how do we do that and how do we do that well. And so generally, those are the kinds of things that, you know, we're starting to dig into. How do you extend the benefits of the integrated model to more people and more places? Sounds like it might be an easy thing to do, but it's actually quite complicated as you get into it.

Well, as you can imagine, a lot of the work that we do is held pretty tightly to the vest because our charge, again, under that sort of umbrella of delivery system modernization, is to help the organization think about where it goes next. If you think about a strategic plan, our work may be 3 to 5 years out from that plan, right? Testing, looking at opportunities, working future or market back. How do we solve human need business needs simultaneously kind of testing core assumptions around some of those possibilities and ultimately whittling them down to 1 or 2 solutions which in a couple of years become core to the business. So that's a general answer. I'll say. I think part of what we and many organizations are looking at now broadly is how do we really effectively take care of populations? How do we extend evidence based care and population health to more people in more places? The benefit, of course, of Kaiser Permanente historically is that our business model had these has these really well aligned incentives, right? We're a payer and we're a provider. And so we are incentivized to do things that others are not like to invest in prevention and screening and and so forth. When you get out of that sort of integrated or closed model into a multi. Payer environment, things become instantly more complex. And so if we want to extend our influence, we've got to think about how do we do that and how do we do that well. And so generally, those are the kinds of things that, you know, we're starting to dig into. How do you extend the benefits of the integrated model to more people and more places? Sounds like it might be an easy thing to do, but it's actually quite complicated as you get into it.

Even for Kaiser Permanente.

Even for Kaiser Permanente.

What are some of the barriers, the biggest barriers still to be solved and enabled to deliver true health care value and reduce waste in the system and improve the outcomes and all the things that go with it.

What are some of the barriers, the biggest barriers still to be solved and enabled to deliver true health care value and reduce waste in the system and improve the outcomes and all the things that go with it.

It's multifactorial, Jeff, as you would imagine. So I'll give you some perspective on this. But it's it's complex, right? I think, you know, one is increasingly, even within an integrated system like KP, increasingly, if you want to cater to a member's preference for choice, things become very complex very quickly because they have options of where they go. So as an example of that, Kaiser Permanente today operates in only a handful of states, mostly on the West Coast, Hawaii, Colorado, Georgia and the mid-Atlantic states. People go on vacation and they vacation in places that are not in our geographic footprint. Sometimes they need health care services.

It's multifactorial, Jeff, as you would imagine. So I'll give you some perspective on this. But it's it's complex, right? I think, you know, one is increasingly, even within an integrated system like KP, increasingly, if you want to cater to a member's preference for choice, things become very complex very quickly because they have options of where they go. So as an example of that, Kaiser Permanente today operates in only a handful of states, mostly on the West Coast, Hawaii, Colorado, Georgia and the mid-Atlantic states. People go on vacation and they vacation in places that are not in our geographic footprint. Sometimes they need health care services.

Right? Right.

Right? Right.

So we have recently implemented what we call a 50 state solution, which allows Kaiser Permanente members to get care that is quote unquote, in-network, if you will, irrespective of where they may be geographically. Now consider that a Kaiser Permanente member, when they interface with us within our geographic footprint, they get a certain type of care and service and experience which they likely want replicated elsewhere as a member. That is a core difficulty to solve for right in the context of value based care. So now the member patient consumer has choice. They've gone to a place that is in this use case outside of our four walls. How do we solve for that? Well, you've got to have a pretty sophisticated data capability to be able to say, okay, well, somebody has gotten service at a place that's outside of our system, but I still need visibility to what's gone on there because that is part of their holistic health record, if you will. Yeah, I need some way of saying, look, the Kaiser Permanente standard of care looks like this. How do I ensure that that member gets it through somebody else? So I think these are some of the core challenges. And then of course, you get into some of the human components which are I can develop a pretty elegant system to achieve those goals, but then I have to get others to adopt those capabilities, those solutions, and I've got to incentivize them in the right way. And so if you just take that one use case and extract, you can start to see that these are the same challenges of value based care writ large. Yeah.

So we have recently implemented what we call a 50 state solution, which allows Kaiser Permanente members to get care that is quote unquote, in-network, if you will, irrespective of where they may be geographically. Now consider that a Kaiser Permanente member, when they interface with us within our geographic footprint, they get a certain type of care and service and experience which they likely want replicated elsewhere as a member. That is a core difficulty to solve for right in the context of value based care. So now the member patient consumer has choice. They've gone to a place that is in this use case outside of our four walls. How do we solve for that? Well, you've got to have a pretty sophisticated data capability to be able to say, okay, well, somebody has gotten service at a place that's outside of our system, but I still need visibility to what's gone on there because that is part of their holistic health record, if you will. Yeah, I need some way of saying, look, the Kaiser Permanente standard of care looks like this. How do I ensure that that member gets it through somebody else? So I think these are some of the core challenges. And then of course, you get into some of the human components which are I can develop a pretty elegant system to achieve those goals, but then I have to get others to adopt those capabilities, those solutions, and I've got to incentivize them in the right way. And so if you just take that one use case and extract, you can start to see that these are the same challenges of value based care writ large. Yeah.

Scale incentives, adoption, adoption, all kinds of things. Yeah. Okay. That's great. Let me ask you about one specific thing. I'll ask you to futurecast a little bit. How successful or how pervasive or how much use will there be of kind of hospital at home? If you were to guess, where is it going to be three years from now and why are you excited about it? And maybe what are some of the barriers there as well?

Scale incentives, adoption, adoption, all kinds of things. Yeah. Okay. That's great. Let me ask you about one specific thing. I'll ask you to futurecast a little bit. How successful or how pervasive or how much use will there be of kind of hospital at home? If you were to guess, where is it going to be three years from now and why are you excited about it? And maybe what are some of the barriers there as well?

Yeah, well, as a good innovator would do well, reframe the question slightly and say, I think hospital at home is a very specific component of care in the home, and that is a specific component of care outside of the four walls of ability. And I think that is absolutely the direction that the industry is headed and needs to head three years on. You know, I think that part of the industry will continue to evolve. I think if you say, look, we want to do more in the home. That's the core objective. What are the difficulties that we have to solve to be able to do that? Well, and I think one of the core difficulties is around last mile logistics. This is a thing that this part of the industry is going to have to figure out. And it's not historically been in our wheelhouse to do so. So you think about Amazon's ability to get really just about any packaged good, any consumer good to you relatively quickly in some instances, even same day. They do that because they have a combination of a technology platform that integrates with physical warehouses. Right. They've got a whole distribution strategy that puts those two things together. That hasn't really been how the health care industry has thought historically. We haven't had that need. But if you're going to start doing more and more in the home environment. You now have to think about problems like that. That is a core difficulty to solve. Remote workforce management. Where do I have specific people specific expertise at any given point in time, and where are they relative to a patient that needs them at that same moment in time? The technical infrastructure many of us probably take for granted that in our homes we have reasonable Wi-Fi and good broadband. But many of our members, many communities across the US are broadband deserts for a variety of reasons. Either good broadband isn't available or it's available at a price that's unreasonable. So that becomes another core difficulty to solve if we're going to, you know, sort of allow for hospital and health care at home models to be equitable, which is a core principle for us. So I'm absolutely optimistic about where that part of the industry will go. It is the right place for us to move for a variety of reasons. I also think we have to get real about some of the core difficulties that must be solved to really unlock that model at scale.

Yeah, well, as a good innovator would do well, reframe the question slightly and say, I think hospital at home is a very specific component of care in the home, and that is a specific component of care outside of the four walls of ability. And I think that is absolutely the direction that the industry is headed and needs to head three years on. You know, I think that part of the industry will continue to evolve. I think if you say, look, we want to do more in the home. That's the core objective. What are the difficulties that we have to solve to be able to do that? Well, and I think one of the core difficulties is around last mile logistics. This is a thing that this part of the industry is going to have to figure out. And it's not historically been in our wheelhouse to do so. So you think about Amazon's ability to get really just about any packaged good, any consumer good to you relatively quickly in some instances, even same day. They do that because they have a combination of a technology platform that integrates with physical warehouses. Right. They've got a whole distribution strategy that puts those two things together. That hasn't really been how the health care industry has thought historically. We haven't had that need. But if you're going to start doing more and more in the home environment. You now have to think about problems like that. That is a core difficulty to solve. Remote workforce management. Where do I have specific people specific expertise at any given point in time, and where are they relative to a patient that needs them at that same moment in time? The technical infrastructure many of us probably take for granted that in our homes we have reasonable Wi-Fi and good broadband. But many of our members, many communities across the US are broadband deserts for a variety of reasons. Either good broadband isn't available or it's available at a price that's unreasonable. So that becomes another core difficulty to solve if we're going to, you know, sort of allow for hospital and health care at home models to be equitable, which is a core principle for us. So I'm absolutely optimistic about where that part of the industry will go. It is the right place for us to move for a variety of reasons. I also think we have to get real about some of the core difficulties that must be solved to really unlock that model at scale.

That's great. David We call this podcast the Health Care Changemakers Podcast, so it's been great to have you on. My parting question for you is what lessons would you give for the aspiring changemaker or changemaker wannabe?

That's great. David We call this podcast the Health Care Changemakers Podcast, so it's been great to have you on. My parting question for you is what lessons would you give for the aspiring changemaker or changemaker wannabe?

It's a great question. There is a technology futurist in the Silicon Valley, Paul Saffo. And Paul has this quote that I use quite often. It's, I think, part of my innovation DNA, if you will, and the quote is never mistake, a clear view for a short distance. And my interpretation of that is this. I think we get to a place in innovation where the idea, the solution is clear. It may be a good one, a really good one. It may be, in fact transformational, or at least we have that belief. But innovation, particularly in complex organizations, is as much about social connection, relationships, politics, how you get things done. How you rally people around a change agenda. It's as much or more about all of that than it is about the idea itself. It's understanding the complexities of the organization that are required to actually drive innovation, not just the whiz bang idea.

It's a great question. There is a technology futurist in the Silicon Valley, Paul Saffo. And Paul has this quote that I use quite often. It's, I think, part of my innovation DNA, if you will, and the quote is never mistake, a clear view for a short distance. And my interpretation of that is this. I think we get to a place in innovation where the idea, the solution is clear. It may be a good one, a really good one. It may be, in fact transformational, or at least we have that belief. But innovation, particularly in complex organizations, is as much about social connection, relationships, politics, how you get things done. How you rally people around a change agenda. It's as much or more about all of that than it is about the idea itself. It's understanding the complexities of the organization that are required to actually drive innovation, not just the whiz bang idea.

It's a great insight and explains why. The thing we tried 3 or 4 years ago and gave up on doesn't mean it was a bad idea then and doesn't mean we shouldn't reconsider it now. Right. Because so many of those other things could have changed. The politics, the relationships, the connections, the macro environment all could have changed since we last considered it, right?

It's a great insight and explains why. The thing we tried 3 or 4 years ago and gave up on doesn't mean it was a bad idea then and doesn't mean we shouldn't reconsider it now. Right. Because so many of those other things could have changed. The politics, the relationships, the connections, the macro environment all could have changed since we last considered it, right?

That's right. That's right.

That's right. That's right.

Well, that was very well said, David. Thank you. It was a pleasure to have you on. David Grandy, vice president of innovation at Kaiser Permanente.

Well, that was very well said, David. Thank you. It was a pleasure to have you on. David Grandy, vice president of innovation at Kaiser Permanente.

Thanks for listening to Prophets Healthcare Transformers Podcast. This podcast is produced by Jared Johnson and his wonderful team at Shift Forward Health and a big thank you to our hosts Priya Nasir, Lindsey Mosby, Paul Shrimp and Jeff Gordy. If you like today's episode, you can find more great content like this at prophet.com/thinking. I'm Anna Kuno, the senior editor of this podcast. Thank you for listening.

Thanks for listening to Prophets Healthcare Transformers Podcast. This podcast is produced by Jared Johnson and his wonderful team at Shift Forward Health and a big thank you to our hosts Priya Nasir, Lindsey Mosby, Paul Shrimp and Jeff Gordy. If you like today's episode, you can find more great content like this at prophet.com/thinking. I'm Anna Kuno, the senior editor of this podcast. Thank you for listening.