Online Healthcare MBA
Disruptive Innovation in Healthcare
Join us as we think outside of the box and discuss the different types of innovations happening in and around the healthcare industry. Let’s explore how entrepreneurs are influencing and re-imagining healthcare.
Dr. Ayman El Tarabishy
Associate Teaching Professor in Management
Executive Director of International Council of Small Business (ICSB)
Interviewer: Good afternoon everyone. My name is Leiki Luud, and I will be your host for today’s webinar, Disruptive Innovation in Health Care with Dr. El Tarabishy.
Before we get started, I just wanted to mention a few things. Firstly, please keep your phones on mute. You can do this by pressing star six. Secondly, we will have a question and answer period at the end of the presentation, so please type in your questions in the chat box at the right-hand side of your screen throughout the session. Lastly, we will be recording this webinar, so you will be receiving a link from your dedicated enrolment advisor in the next few days. Please feel free to share this with your friends and colleagues.
Okay, let’s get started. Dr. El Tarabishy is currently an associate teaching professor of management at the George Washington University School of Business. He’s an award-winning author and teacher, recently awarded the Most Outstanding Faculty, and voted by students four years consecutively. Dr. El Tarabishy is the only faculty in the GW School of Business who teaches in two nationally-ranked programs. He developed the first entrepreneurship innovation and creativity courses offered to MBA and undergraduate students throughout the School of Business.
Dr. El Tarabishy is also the executive director of the International Council for Small Business, ICSB, the oldest and largest nonprofit organization across the globe, devoted to advancing small business, research and practices. ICSB is a correlation of more than a dozen national organizations across the globe and represented in over 80 countries.
In this webinar, Dr. El Tarabishy will discuss how the intersection of business and healthcare can build a better business model for healthcare clinics, hospitals, physicians and ultimately better service and care to the patients. This webinar will also discuss how the GW online healthcare MBA courses integrate the various topics of business, including accounting, finance, ethics and entrepreneurship and to building your knowledge and business skills.
Thank you, Dr. El Tarabishy, for taking the time to speak with us today.
Respondent: Thank you, and can you hear me?
Interviewer: Yes, we can hear you.
Respondent: Great. All right, well, and I want to say thank you for hosting me here and I want to just welcome all the prospective interested students and the prospective professionals in this webinar. I see we’re, the attendees keep getting larger and larger, so hopefully we’ll hit 100, and then we’ll have a record today. How’s that? So, what I want to do is just allow everybody to kind of think creatively here a little bit and sit back and say okay, you know, this is an interesting topic. So let’s kind of see what he has to say about it and how does this fit into the GWMBA program, and if this is something that’s interesting to me, and how do I act upon it both professionally and personally?
So the title of the presentation here is basically Disruptive Innovation in Healthcare. It’s interesting we used the word “disruptive” and for the most part, most of you will remember that even in grade school and mid-school, if you were coined as being disruptive, that was a bad thing, how the student is being disruptive. So he’s causing chaos in the classroom. He’s interrupting people. He’s taking us in different directions. But today, the word disruptive has taken a positive connotation, and it’s specifically in the healthcare industry and mainly in other industries that need some innovation in it.
So let me start moving the slide here. I use are a lot in my classrooms because combining all your senses and thinking helps you articulate better ideas, in my opinion. So I’m going to refer to Rothko a lot and his paintings here, and kind of some of the meanings that he brought forth in some of his paintings. So I’ll start quickly with this painting right here in which he says, “We favour the simple expression of the complex thought,” and us as humans, in general, we try take complex ideas and problems and try to simplify them, and there’s a reason for this. We want to make it simple for us to understand, to figure out exactly what we need to comprehend to quickly solve the problem. Right? And most of us will jump in and say, okay, we have a problem. How do we solve it? And everyone takes out their hammers, everyone takes out their calculators, and everybody starts writing memos and emails trying to solve the problem.
What we don’t do is we don’t spend some time trying to articulate what the problem is. What is the situation at hand, right? What is this complexity that we need to try to define? And we try to avoid this because the more we spend time on articulating the problem, we feel that we are wasting our time. We want to solve the problem to kind of scratch it up as a success and hopefully get it promoted and then move on to the next problem to solve. But imagine if you spend most of your time trying to articulate what the problem is, then maybe the solution will come much easier and with less resources, and you’ll actually enjoy solving the problem.
So that’s something for – food for thought. So let’s get into this whole discussion, what is this problem, right? What is the problem that we’re trying to solve? And it’s very simple. Like I said, how does disruptive innovation take effect? Right? How do we – Can we combine two words, both disruption and innovation, together and what does it mean we combine these terms in one sentence? So what we know here is that if you look at history and if you look at all different industries here, wouldn’t we have something new? Right? When we invent something new, when we have a new innovation, usually we target it to the people that can afford it. Right?
I could ask a simple question here, and we’re close to 98 individuals. How many of you went out and bought the first iPhone, or the first iPod, or the first iPad? How much did you pay? I remember the first iPhone was $600 or $700. The iPad was the same thing, and we would go and be, as the early adopters, we would go pay for it right away, and it was expensive. I remember our laptops that would cost $5-$6,000, or computers that would cost $6-$7,000?
So the industries usually would create new products and services and expect that the wealthiest, the people that can afford it, will buy it first, but then something happens. Then innovation starts taking hold, and then we start reducing the price of these innovations. It’s simple math, really, right? More people want it. We say okay, well if more people want it, we can sell 100 of these items for less money, and we can make more money. So now iPods and iPhones go for what, $199, $99 maybe, if it’s used or refurbished, right? And we start reducing the cost of these innovations for mass consumption, right?
And yet, there’s some disconnect happening here. Right? Healthcare doesn’t work this way. Healthcare should be affordable for everyone, not just for the people that were the wealthiest, that have the most money. They can spend the money right away, immediately. So who pays for this? Because typically industries will say, no, no, these are innovations. You’ve got to pay for them. And yet society as a whole says, wait a minute. We should treat everyone equally for the most part. So who’s left with the tab? Well we’re paying taxes, aren’t we? So the government should come in and say okay, well, you know, we need to give it to people that can’t afford it. So then the government starts paying for healthcare subsidies.
So, in a way, we have this struggle between what’s really cool and nice and innovative and we want versus people that cannot afford it right away, and what’s the role in government in it? So then we talk about potential enablers. Technology. How can technology make life easier and more affordable for us? Changing our business models, how things are done. Think of IKEA. Think of one-stop shops that come in and say you can get everything all in one spot, right, or a whole value network all working together seamlessly. And we’ve seen this in the early 1980s with these airline alliances. So now you buy a ticket with United, but you connect with Lufthansa, you connect with Swiss Air. You’re connected with all different airlines. Why? It’s not because they like each other. They’re competing with each other, but they realize they can make more money if they keep you in one ecosystem, in one system. So they create what we call collaborative environments, saying okay, we’ll split the ticket X amount of ways, but let’s keep them all within our ecosystem.
So, what Rothko will say is, “We are for the large shape because it has the impact of the unequivocal.” We always want to see the big picture because then we can make one general statement, or a general writeup on it and saying, here’s how the whole system works, kind of like what you are doing right now at work and in the systems that you’re in. You’re always talking about the system, the administration, the leadership, the people in charge, and they all come out with these long statements saying here’s how we move, but in reality the parts of it are as equally important, or more important, and maybe that’s why you’re here, to say, well, I’m a part of this whole system and I’m interested in changing myself, or trying to figure out a new role for me within the system.
So, let’s look at what happens when systems break down and companies don’t innovate or put in some disruptions in themselves. Kodak in 2007 was valued at $8 billion. In December of 2011, it was close to about $300 million. It went bankrupt since then. Right? So if you were working for Kodak from 2007 to 2011, you probably were laid off, or you jumped ship quicker than anybody can think of. Look at Blackberry. Most of us five or ten years ago, 90 percent of all users of cell phones had a Blackberry, and we were really good at typing messages and emails using our Blackberry. Today Blackberry is no longer in the consumer business as it was, right? It’s more on the enterprise system, and we’re all using Samsung, or using Androids and iPhones. Blackberry now is a niche market. Now I’m one of those niche markets. I still have a Blackberry, but I have the new one because I‘m still not used to this touchpad thing. I like the keys here. And by the way, Blackberry’s coming out with a new phone called Passport. So I’m a fan of Blackberry.
But the point is here, see what happens if you don’t have disruptions or innovations in your system, in your industry, in your company? You can see your days are numbered. Yahoo. I was reading the Wall Street Journal this morning and Yahoo basically, the only reason they’re surviving is that they invested almost seven or ten years ago in a company called Alibaba, which is now valued at $150 billion in IPO coming out in the next month, or over the summer. That’s the only reason they have value now. Their sales, their ad sales are down, their gross projections are low, and they’re trying to buy new companies, hoping that they can reignite their growth, but the industry itself, the whole sales business, is not what they want. And I still haven’t heard anything about Yahoo and mobile phones and what they’re tapping in to, yet FaceBook, now most of its growth segment is on advertisement on cell phones and mobile phones. Google’s investing a lot.
So you can see that I’m continuing this conversation over and over again and realizing from the private sector, right, if you don’t innovate, basically your days are numbered. So let’s take this and apply it to healthcare, and let’s specifically talk about healthcare. If you look at Christensen’s book on the prescriptions dilemma, which is one of the core requirements of one of my courses in the healthcare MBA, is he basically says disruptions happen in different formats. It can happen in [ethnology 00:13:12.5], right, and he talks about it as inputs from labour materials to outputs, which has greater value, but yet are affordable, or in the business models. And he comes up with a couple of ideas. Solution shops, hospitals that include fee-for-service. Imagine that. You go into a hospital and you say, okay, it’s not just one bill. If you want this, this costs this, kind of like a shopping cart. Imagine yourself going to the hospital and doing the shopping cart model; or result-based, and once I get the results, I’ll pay you versus, you know, I’ll just charge it right off the bat. Value-added processing, right? Facility networks.
You’re part of a broader network, right? So you think, has the healthcare industry – hospitals, physicians, administrators – started looking at the disruptions within the healthcare industry? Right? Technological enablers. I’m not sure how many of you are gadget people that always go out and buy new gadgets and technologies. I am. I think I have three different types of tablets, right? And I bought the Microsoft Surface, and I have an iPad, and I’m thinking of the new IBM ThinkPad tablet. But tablets or technological enablers allow me to change the way I work. Now I can actually do work on a plane versus pulling out my whole laptop.
So telemedicine is a fast-growing realm that we should look into, not just in the United States, but globally and developing countries, right? Internet and the Cloud, right? Now you can store information, but even if you store information, electronic medical records, or more importantly, electronic health records, how does tie to HIPAA rules? We haven’t even opened the discussion on this and the challenges of this. Look what happened to Target and the credit card fiasco they had because they weren’t protecting the data enough.
Precision critical decision-making. Imagine if you have a question and you were really not sure, and you just keep it as generic as possible, but with some specific information, and sent it out to the Cloud, and you get another 20 physicians from around the world giving you input, right?
Personalized medicine. Why do I have to take my records, physically go from one place to the other versus having it all on one chip and I can take it around the world with me? If I’m in Italy, or if I’m in the US, or I’m in Canada, the whole connotation, the whole semantics of it, the taxonomy of it, all remains the same. Right?
Imaging techniques. Again I hear an NPR about mammograms. We’re talking about 3-D versus regular x-rays, and now we’re talking about potentially new technologies out there, yet they’re saying yes, they’re better. They’re much more improved, but the cost is six times as much, and I stop and smile. I’m like, for the time being it’s six times as much. Now somebody’s going to come in and say, I can produce the same thing for one-tenth the cost. Disrupting a hospital business model, right?
So this is one of the key things you should consider about this MBA program, that you’re not coming in here just to kind of say, hey, you know, I’m going to just learn some skills. Well we like you to do this, to come here and leave as disrupters, and thinking and articulating problem statements. Why? Because we want you to go back into this workforce and saying, have we looked at this, our hospital, or our clinic, or my partnership with individuals from a whole new different angle? Example: Campaign Zero is one example, adding value to the patient. Now we’re not talking consumers because if I’m talking business, I’m talking about the consumer. What does the consumer want? But if we’re talking healthcare, yes he’s a consumer, but he’s also a patient. So there’s a double responsibility here, not just to him as a consumer, but also to him as a patient and their safety. Right?
What about the culture of the healthcare facility itself? Look what’s going on with the veterans and the fiasco of these hospitals. Is this just a leadership problem so we ask the leader to step down, or is it really a systematic culture problem that they were not investigating, changing, and [nullifying/mollifying 00:17:50.8]? Or more importantly, and this is a much more complex problem, what about the climate, the organizational climate within the different departments? So radiology have a climate, the physicians, the surgeons have one, the nurses have one. They have different climates. Some are very positive, collegial. Some are very competitive. Some are absolutely negative. So how do you deal with culture with an industry like this? What are the leadership skills, the managerial skills that you need, right, and what I call some of the simple skills you need and understanding you need as being very human and caring? So we talk about that in the MBA program, and we approach it from many different angles.
We talk about a physician practice business model. So we can talk about our rules-based medicine. Right? Primary care. We can also talk about primary care in an [oversight] of patients. Fee for membership. So you pay a fee. I’m not sure how many of you saw the movie, the Dallas Buyers Club, in which he was bringing in medicine from Mexico to deal with HIV and yet he kept getting challenged by the system, by authorities saying no, no, no, you cannot sell this medicine. So what he did is, he said, okay. Very disruptive, very innovative, he said, I’m not selling it. I’m selling membership. A nice pivot, literally a very smart pivot, and now they couldn’t stop him. Now he’s actually selling membership to his club, and in that membership benefit is, you get X amount of products and services. Well, you know, we kind of laughed about it, saying, oh my God, this guy drinks a lot and he’s not really smart, and he’s dying, so he’s desperate, but was he really, or was he a really shrewd business man that helped solve a health dilemma, a crisis of sorts?
Traditional intuitive medicine, again, we can use the fee-for-service, or wellness examinations, and how does that fit into the whole model? So pieces of the puzzles. What I like to do with the students is, I like to ask a lot of questions. And once I ask these questions, go solve the puzzle. Go solve the problem. And yet, most of you will not solve the problem because you haven’t asked the right questions. So again, you have to go back to articulating what the problem is actually. Is it the wellness? Is it the rules-based medicine? Is it the oversight? Is it the traditional intuitive medicine? Or more importantly, have we ignored other aspects and does it have to be a circle? Why can’t it be a square? And why is it a circle? Why isn’t it a triangle? Right? And why are we not dealing with the missing middle? And that’s kind of what you get into in the MBA program, is that you question your assumptions. You question the way you’re thinking about things. So now you’re saying, well you know Dr. Tarabishy, this is great, but I [refute/refuse that 00:20:57.3] it’s a circle. It’s actually a triangle, and what we’re talking about is the missing part.
All right. We can talk about speciality physician disruptors, you know, and telephone, we can talk about the iPhone. We can talk about different Skype technologies that are coming out, high-def, you know. Like you saw the iPads and they’re saying high-def or retina. I’m like, this is great if we can use it for healthcare. Now a physician can actually see what’s going on. I have twin boys, right? They’re four years old. Now one of them had 101 degree – he basically had a fever, and my wife was travelling on business, and I would call the doctor, and the doctor wouldn’t answer me. So I can take him to the emergency room, spend four hours in the emergency room, or if there was a service, I could just call up, pull out my iPad, show him the little boy that’s crying at midnight, and they can say, okay, well have you done this? Have you done that? Can you please let them open their throat? That would have been easier for me. I would have paid for it, by the way, you know, extra service, like by the minute, or by the hour.
All right, nature of business, chronic versus preventative, you know, how do we look at the whole picture, the whole environment and say to ourselves, how do we take this and reconfigure everything from wellness centre, to education, childcare, to libraries, right? What does childcare have to do with preventive healthcare, with a wellness centre? Why can’t I have membership to both the wellness centre and the childcare, and to the education? And saying, if you sign up membership for all three, I’ll give you a discount across the border. So then you come in and you don’t have child obesity. Because why? You take him to the wellness centre, right? I live in Arlington County here in Virginia and we have a very robust system for young kids, young tots, to play soccer, swimming pool and so on, and so on, and so on, and it’s very busy, and they’re making a lot of money on it. I paid $150 for swimming lessons for four weeks. That’s a lot of money, but it’s good stuff.
Role of government. All right, so we can’t just ignore the government. We’re in Washington, DC. They’re like five blocks away from us. So we need to talk about regulation, assurance. You know, I don’t know how many of you heard of Nighthawk and what they’re doing, and naturalized healthcare. The whole debate two years ago in the whole program was Obamacare, and there were a lot of heated debates in the classes from a policy perspective saying, well, policywise, it’s not going to work. From a healthcare-wise, it’s a nightmare. From a business, and the exchanges, well, okay, how are you going to make money on this? You know, are these insurance companies going to sit idle? Of course not. As soon as something went wrong, they sent termination letters. Don’t you think they were kind of happy when they were sending these termination letters? Of course they were. Right? It was retaliation in a nice, business professional way.
So you have to look at the players and how the players will react to the different dynamics of innovation that are coming in. Again, if you look at the Wall Street Journal today, imagine if Steve Jobs was still alive, and you read in the headline news, “Apple and IBM alliance.” So IBM can sell its apps on Apple iPads for the different industries. Right? So it’s like basically making a deal with the devil. Apple and Microsoft and their commercials are now saying, no, no, no. We need to be friends here because competition is heavy coming in, and if we don’t strike this business-consumer relationship. Right? You have the design. We have the business savvy. We need each other. Then it’s not going to work. So now they’re saying, okay, let’s just [unintelligible 00:24:55.9] our differences and all this drama and let’s work together.
Similar with government. Government realizes that the healthcare costs keep going up, and if they do not get involved with the private sector, then they cannot stop this inflation and healthcare costs. The business side will come in saying, I’m not doing this for free. I want to charge money. I want to make money. So, therefore, give me access. Create regulations that are friendly for me, but at the same time, I will help you. I call it the old guard versus the new kid, all right, and I put pictures of kids right here: current model of healthcare coverage versus models proposed. You know, and we look at pension plans, or defined benefit contribution plans, and what they get out of it versus what you put into it. And you can start looking at there’s potentially some sort of crisis that’s going to happen, and there’s going to [be] a lot of rushing around, trying to figure out who’s going to be on first base and second base. But the point is, from all of these dynamics happening here, what’s your role in this? What are you doing about it? Are you going to maintain the status quo, or are you going to pivot yourself in a whole new role to tap in to potentially the opportunities there, or to defend yourselves from the threats that are coming?
So we look at different theories in the program, and if you’re going to be in the MBA program, you’re going to see a lot of two-by-twos, right, and tables and models to look at. So what we’re going to be looking at here from Kerckhoff’s typology of firms is saying, well, you know, if we look at innovation and growth, we can take companies, large, small, medium, and divide them up into basically this typology. What we’ll have is companies that are basically constrained because of innovation and growth, or you have some core companies that have low innovation, low growth. We know who they are, right? All what we should be looking at is this new generation of companies and small and medium enterprises that potentially will revolutionize or create an evolution in the healthcare industry.
So what we’re looking at, right, not the cash cows and all those words that you’ve heard in the past, but we’re looking at a whole new type of firms. Those are the ones that are ambitious, that are glamorous, right. Those are the ones that sell for $16 billion after two years. Are you one of those? You know. And how do you join those companies? Would you leave your current job and join a start-up that is doing high-def healthcare services using iPads? How much tolerance for risk do you have? Or are you ready launch a new service within your hospital or clinic with Cloud healthcare?
I want to stop here and then tell you how this all fits into the healthcare MBA program. So I say it as learning how to ride a bicycle again, if you get into this program. So initially, what you will be doing, most of you will be doing, is what we call the core body of knowledge, or the CB case. So you’re going to get back to basics and really understand the topics of finance: accounting; marketing; operations; strategy; HR; leadership; things that you may or may not have taken in the past, or kind of were left to deal with them without you understanding what are the theories behind this? Where do they come up? Where are these concepts coming from? What’s the rationalization for them?
So in the MBA program, you’re going to be basically taken, saying okay, here’s the bicycle. We’re going to get onto this bicycle and we’re going to learn all this stuff together. And as if you’re learning a new bicycle, some will come easy. Some will be very difficult. Some of you will fall off, but you definitely need to get up again. And you’ll need to start rebuilding your skill set, and start questioning some of the assumptions that you had on all these topics and saying, how does this fit into the current environment that I’m in? How can I learn? What do I need to learn about social media from a marketing perspective for my current clinic? Right? Should I be answering patients using emails? Or should I be using Cloud computing? What about accounting? What about finance? Right?
For example, let’s talk a little bit about finance. This is a sample slide I’ve taken from one of my presentations in my classroom, and we’re talking about valuation tools, and I say there’s two parts: present value and capitalization, if we’re going to compute the present value of a company, or a hospital, or an initiative, or an investment versus a capitalization approach. So we actually go in and start talking about the different ways of computation. Now I know we’re almost at 124 people here, which is interesting, some of you saying, and I’ll give you a Chevy Chase skit saying, I didn’t think math was involved. Math is not involved. It’s not about math. It’s about understanding these topics and saying, I need to understand this whole concept of present value. What do we mean by present value versus future value? Is it just about capitalization, or are there different valuation techniques?
So when someone comes up to you saying, well, I want to buy your clinic, or I want to invest in it, how much sales have you done? How much have you been doing in business for the last six months? I’ll pay you five times as much as how you were doing. Well that’s one way of doing it. That’s called cash flow. That’s looking at your sales and multiplying by five and saying here’s your value on it. You say, well, thank you. That’s one way of doing it, but I’m going to look at three, four different scenarios. This is when you start talking business, and it’s funny you’re talking business in a healthcare setting.
So you might not know how to do the math on it. You might not know how to solve the problem here, or the formula, but you call your accountant, your financial advisor, saying, hey, I’ve learned this in my class about this present value and future value. I know a little bit about how to do it. I’ve done some problems. I got a B- in the class because I solved it wrong, so show me exactly how to compute it. And this is when you become an executive. This is when you start saying, I’m not just a physician, or healthcare professional. I’m also a business executive. I’m making business decisions. And you can take this across the board from the different topics.
So this part is what I call the CB case, the common body of knowledge. You should learn, understand and apply the language of business in healthcare, and you should not feel threatened. You should not feel that you don’t know anything about it. Once you finish the MBA healthcare program, you’ll know how to talk business.
The other part of the program is what I call the electives. What I say is you challenge yourself, right? These are the things that you always were interested in. You didn’t have the time, or you didn’t k now where to start, or maybe you watched some TED talks and you said, oh this is a really neat topic. I want to get into it, but I’ll do it later. So here are some of the electives that we propose.
Entrepreneurship. You know, that’s one of my courses that I teach. It’s basically saying, well, let’s talk about you maybe thinking of starting or expanding a business. All right, so let’s talk about entrepreneurship from the beginning to actually putting together a feasibility study for me. And you start the class saying, oh, this is a great idea, and you go out with your significant others and maybe other couples, and you sit at the end of the evening after six glasses of wine, you’re all multi-billionaires. And the next morning, you forget the idea and you don’t do it anymore. But in this course, you actually have to have gone through the whole idea, and after the course you’re saying, well, I thought I was going to be a millionaire, but now it seems that I’m going to be working 80-hour weeks, and at the end of the year I’m only going to make $20 thousand for the first three years. Maybe it’s a great idea for dinner, but it’s not something that I want to pursue, or alternatively saying, I always knew this was a good idea. I’m actually launching the business next year. And I’ve had both in my class.
EMR – Electronic Medical Records. It’s another elective that we do, and we just don’t talk about the technology. We talk about actually application of change within this process. Some of you, if I ask this now, how many of you have implemented EMR systems in you hospital? I’m going to get three answers, three types of answers. One: We did it. It was a disaster. We lost so much money. We don’t use it. What a waste of time. We actually lost people because of it because it was implemented poorly. Two: It’s still a work-in-progress. We’re struggling with it. Or three: It went very smooth. We love it. We see the return on investments. So what happened? Was it just the technology? Was it the people implementing it? Was it the leadership? Was it actually the way it was implemented – the process? So this course takes all of this into account, and we actually have fun with it, and we do an online simulation, which you actually have to do in virtual game. So as your children are playing Xbox and PlayStation, you’ll be doing an online simulation, trying to get people to sign up for your system. And I kind of threaten the students saying, if you don’t do it well, you fail the class just to get them all going.
Then the other one is Innovation and Creativity, and I call this arts-meets-business-meets-healthcare, all right? So we go back and we actually tap into your creative mindset and seeing the [number 00:34:49.6] of days you are being creative. What happened to these days, and why aren’t you still working using your creativity while you are doing business and while you’re in the healthcare industry, right? What’s stopping you from this? And what I hear most of you saying, it’s not that I don’t want to do it. It’s just I lost how to do it. All right? And we get into this course and talk about the theory and the application of it.
Social Entrepreneurship. You know, I see a lot of healthcares really talk to social entrepreneurship, and a lot of the healthcare – hospitals, they say, we are nonprofits. What they should really be is, there should be social enterprises. They should be generating a profit for themselves, and they should use the profits that they’re generating to pay their physicians well, their nurses well, everyone well, but also deal with patients more, and help more patients. So it’s a triple bottom-line approach. You know, make money, do social good and help the current environment.
And finally, a course, Knowledge Management, it’s more of a theoretical, philosophical and a business course saying, well what do we mean by knowledge versus data versus information, and how do we manage these resources? And that’s currently a course I teach with my students in the summer session.
So these are the electives that I ask people to take, or there are going to be other electives, although those are the ones that I’ve brought forward, and some of them I teach, and some of them others teach. But those are the ones that you’ll look into and start saying, oh I want to take these courses. So you start going shopping for these courses, tying them into your interest area.
I mentioned about disruption and innovation in the healthcare industry and currently what you’re doing. Same thing that I preach and I talk about and I lecture about, we also do it in our healthcare MBA. So we’re in the works, there’s actually a bunch of courses that are in the works that we will start to apply or introduce as electives in the future. So some of them – and I know because we’ve done our market research. We always need to do our research, that’s part of being an entrepreneur, knowing what’s out there. So these are three types of courses that we are looking at and topics that we’re looking at. One is big data and health, right, or data, Linux and health, so whatever words you want to use, and each word has a specific definition, but this is something that we’re looking at as well for a potential course for ourselves. And that’s important.
All right, then, there’s a tidbit. Most of you would know this, say, but Google knows when there’s an epidemic of the flu before the CDC does. Why is because people go in onto the site, onto the Google search and say, runny nose, fever, feeling achy, and Google taps all these queries and says, wait a minute. This is in the Midwest, or this is in the east coast, and they [unintelligible 00:37:33.3] and they’ve done a map on this, and they show the lighting. It starts to light up before the CDC can track how many of these came in. Well, for me that’s big data, right? They’ve taken all these data inquiries, these inputs, and actually turned it into visualization. So part of the course is you’re going to start doing some projects on this using Tableau and other tools to do this.
Lean Healthcare, or Lean Six Sigma. It’s not just business, but we’re going to bring in the engineering side of it and saying, oh, let’s apply some engineering theories, Lean Six Sigma, to healthcare. Some of you are doing it. Some of you want to do it. You know, you can get certified on it. There’s a black belt, and there’s a green belt. So we start using prophesies and the Lean system, right, to healthcare, but see, that’s nice. That’s very neat that we’re applying all this stuff, but from a business perspective, what’s the return on investment on this? So when you go to your supervisor saying, I want $6,000 to go get certified on Lean Six Sigma, it will be like, great, but that’s a lot of money. So what’s the return? He says, well the return when I come back, well we examine how we deal with our flow of patients, or how we deal with our accounting system, or how we deal with a system and offer solutions to it. Maybe change our business model as part of it.
I’m not sure if you have all heard of Population Health. This is a very hot topic right now and it’s gaining attraction, even though it’s been around for the last 30 years. But it’s not just public health, or public policy for health, it’s called population health, or sub-segments of population health. All right, so it’s not just the patient that we’re looking at as an individual. Let’s look at the patient from a population health perspective. How we design programs, system initiatives to deal with population health and its segments, right, from both a business perspective, a public policy perspective, and a healthcare perspective. Right? So how do we create innovations in this target segment to deal with these requests and what I call opportunities? And this is another topic that we’re looking into, and the public health people do not like us not this because now the business side is saying, wait a minute. There’s potential business in this whole topic of population health tied to big data, tied to potentially some other topics that we’re looking at.
We have study abroad programs, so even though you’re virtual, part of the access for the MBA program is you can tap into Study Abroad. The way we’ve done it – and I know I have a colleague, Anna Helm takes students to Sweden every May or early June for about two weeks, in which they go pitch clients in Stockholm, Sweden about healthcare products and services – and so, one of the ones I know, I’ve heard about, is that somebody invented a new healthcare tool, and he said, I want to bring this to the United States, but I also want to bring it to the developing countries like Tanzania, like Nigeria.
So you as MBA students that have industry experience will now try to understand what the product is, try to understand it from a patient perspective, from a clinical perspective, from a hospital perspective, but the client also says, can I release this product? What is the marketing behind this? Right? How do we do the operations? What kind of company should we create this in, right? And you actually have to put all this together in one broad picture for them and present it in front of the client. So imagine yourselves as a doctor, as a surgeon, sitting there and explain to him, saying well, you know, the business model, the marketing four p’s, or five p’s, we’ll do it this way, but also we’ll try to figure out the financing of it in this model.
So, and South Korea, we go there, learn about social entrepreneurship. [unintelligible 00:41:35.1] and DC is also about social entrepreneurship, but we also have a course called Entrepreneurship and Peace, and that’s a four-day intensive course over the summer. So you come in for four-five days. You get to visit the Peace Institute. You get to visit the Royal Bank. You get to visit multi-national organizations in Washington, take a course on campus, feel like a student, and then you get elective [for it 00:41:54.6], and Italy is in the planning stages.
We’re looking at southern Italy, looking at the different industries there and other programs and pop up, and I think your advisors can list you all the different programs and study abroad from London to other countries, China and so on, that you can go into as part of your elective system. So this is part of the GW MBA program elective system and Study Abroad programs, and this is one of our key signatures for an MBA program.
Final comment: on our site, we say it’s an online healthcare MBA. What I’d like to really stress, it’s the business of healthcare. That’s what you’re getting into, and at the end of the journey, you should delve into the healthcare industry itself. Understand it. Understand what are the challenges? What are the opportunities? What are the threats in the industry itself? But more importantly, really the focus is on you, right?
I come back to this whole bicycle analogy, right, is if you were here, and if you’re going to invest two years of your life and spend all this money, you need to understand that you’re coming in here to retool your skill set, your thinking, and actually a little bit about your spirit and the energy that you bring forth, all right, because you’re going to be a lot of times in the evening by yourself on weekends. When people are enjoying themselves, you’re saying, why am I learning cash flow? And you’re going to be challenged, and the point is saying, you know, if you’re going to do this, this is the time to say, this is for me. I’m going to be selfish, and I’m going to do it for myself because I’m really interested this challenge. I’m interested in learning, and I’m interested in actually applying all of this, but more importantly, I care about doing well, being more human than ever before, and actually enjoying it and having fun. Right? But it comes with a price, which is the time you’re going to spend and the effort you’re going to put in.
So on that note, I’ll stop here and then open it up for discussions, or questions.
Interviewer: Great. Great. Thank you so much. So we do have a couple questions. The first one is what are the possibilities of creating a good mix of traditional clinic, urgent care and offer total medicine using available tools?
Respondent: That’s great. That’s a great topic that you can have in my entrepreneurship class. So I’ll turn it around and say, okay, so what are you thinking?
And propose a model for me and put it in some sort of feasibility study for me, and tell me how much it’s going to cost, who’s going to help you do it, what’s the implementation strategy – and have you tested this before, or are you just putting it and thinking it’s going to work? So I’m going to ask you to do actually more of a lean start-up model and saying, go interview three people now and ask them to buy into this right away, before you proceed. That’s my answer to this question.
Interviewer: The next question. I would like to address this topic of telemedicine. As a paediatrician, I considered joining a telemedicine practice that would have addressed exactly what you wanted, Dr. Tarabishy, but my biggest concern was malpractice and liability. Since Tort reform is not evolving as quickly as medicine, how should a physician approach this sort of practice risk?
Respondent: You know, it’s interesting. That’s a good take. So what we learned from Google is that they always say, we’re going to try this and we’re going to – If you look at the early days of gmail, they always put gmail as beta. Do you all remember this, the gmail beta version? They always equated the launch of their products as beta, right? So you need to be a little bit creative about this. If you’re going to join this and try this, right, you might defend yourself, or protect yourself, in a way that you’re saying if you’re going to do this, this is a beta program.
You have to understand the challenges that come with it and actually ask individuals to give you release forms for it so they totally understand what they’re getting into. Do not promise something and you don’t see in the mirror, right, where you’re – what’s coming at you and you don’t know where it’s coming from, right? So you’ve got to be careful.
So I would say, why don’t you pivot this as a beta concept and see how many people sign up? And why not do it in partnership with a state, or within a healthcare institute that’s government supported somehow. So bring in the government people, and then when the government people want your help … So figure it out this way.
Interviewer: Great. Thank you. The next question: I worked at a practice where they thought about introducing telemedicine. The challenge was the reimbursement logistics.
Respondent: And the question is?
Interviewer: How can we overcome the payment model?
Respondent: Okay. So you are looking for a solution here. What’s the problem exactly? That’s too broad.
Interviewer: Okay, I’m just waiting for –
Respondent: Yeah, let him come back, but he might not answer it, but the point is, you haven’t clearly defined the problem. Overcome what?
Interviewer: She couldn’t get reimbursed.
Respondent: Okay, so now let’s talk about reimbursement. Who’s reimbursing you, and what methods of reimbursement? See? That’s the same problem that we’re currently having with mobile phones, right, and purchasing things on your mobile phones. Currently, if you go and buy something, everybody’s asking you to use your credit card. Why is it that you cannot use your mobile phone and tap it in front of a screen and you get charged for your groceries?
Oh I’ll tell you exactly why. The mobile companies, the service providers, Sprint, T-Mobile, AT&T, Apple, the Samsung that are producing the hardware, and actually the businesses themselves and the banks are all fighting in that industry. Who is going to charge whom? And Visa’s in the picture, and Visa says, wait a minute. We’re the most secure network, right?
But here’s what’s going on: T-Mobile, Sprint, AT&T saying, you’re using our services, so we should keep the credit card information, and charge you for it, and send you a bill. That’s what the service providers are saying. See, now you get your phone bill plus your charges. So now you just pay the phone company, you know, airwaves, $200 worth of groceries, $150 worth of dinner, $20 worth of movies, right? They send you all this.
So the phone companies want all this money. The iPhone and Samsung and the hardware people are saying, hold on a minute. You can’t do this because all this information is stored in a chip on my [unintelligible 00:48:32.6], which is a hardware. So no, no, no, we want money. We want to store it. It’s ours. And Visa’s saying, you cannot do any of this stuff because you cannot use the network. It’s our network.
So what happens if somebody hacks it? They still trust Visa. They still trust American Express. The same thing that’s happening in yours, it’s all about the money. Follow the trail of the money. And now what’s going on, in the US they’re arguing about it.
In Canada, they’re having a summit, kind of like think of the Godfather. They’re all sitting around the table saying, okay, how are we going to slice and dice this so everybody makes money? And that’s what’s happening. Kind of neat, right? The Godfather in Canada.
Interviewer: The person who asked the question was referring to third party payers that wouldn’t reimburse.
Respondent: Yeah, they’re seeking more money. It’s about the revenue. It’s about the margins for them.
Interviewer: Insurance companies.
Respondent: Yeah, it’s all about the margins. So ask them how much do they want out of this?
Any other questions?
Interviewer: Yup. What is your view on potential big data sharing and public information transparency?
Respondent: It’s going to be a disaster, right? It’s going to be a disaster because the struggle now is privacy of information, manipulation of the data, and actually the usage of it, It’s basically what I call the Wild Wild West. It’s going to happen in the next five to seven years, and it’s here to stay, and it’s not going to go anywhere, right? So now all that needs to happen is there needs to be some sort of what I call the ethical group to come in and say, this is what’s right. This is what we need to do, and not because of business reasons, but what they need to keep in line and always focus as a number one priority is what is the best for the patient? Patient safety because that’s the most critical, because we’re not talking about just profits here, we’re talking about life or death situation of human beings, right? And that’s the ethical dilemma that’s tied to it – business dilemma tied to the technology dilemma, all together.
Interviewer: I have another question. A problem with the current model is insurances don’t want to pay for services like telephone encounters, telemedicine, so why should we invest in this if we can’t get paid?
Respondent: Well they don’t want to invest. The word that you say, they don’t want to invest yet, okay? that’s the issue of timing, right? It’s prevalent issue of timing because they haven’t yet tried to figure out how to monetize it, and it’s not that they don’t want to monetize it. They don’t know how to monetize it, right?
So let me give you this example. Just recently the Supreme Court refused – There was a company. I’m not sure what it’s called, but it created this new invention saying that they can take airwaves of shows, store them on little antennas, and then you can sign up for subscription-based, and you can watch these shows play later on, okay? And they had subscribers for it, and it went all the way to the Supreme Court, and basically the TV industry’s saying, no, no. This is copyrighted material. This is basically stealing our copyrighted material. And the person is saying, well, yes it is copyrighted, but once you put it on public airways, it’s public domain. Well the Supreme Court sided with the television industry, saying no, it is actually copyrighted material, but in their definition of it, they were very vague about one specific term.
So now what’s happening here is other companies are saying, okay that’s our opportunity. So the whole industry, the whole way we think if cable, copyrighted material, shows and everything is going to change in the next five years, right? And again, if you read the paper, Rupert Murdoch is trying to buy Time Warner for $87 billion. So he’s changing the whole ecosystem, as well, right? He’s trying to tie it in to all the different aspects. Look at what Bezos and Amazon did with The Wall Street Journal, with The Washington Post.
What does an online retailer that sells products and services want to do with The Washington Post? Well, think about it. Bezos knows that Alibaba is coming in to the market, so now, with a new company called 11 Main, which is equivalent to what Amazon will be, or what is Amazon. In the next six months to a year, you can go to Amazon, or a new website called 11 Main and actually compare the TV you want to buy there to that site, and there’s a slight difference. Over there, 11 Main, their direct suppliers are China, Philippines, Indonesia, and South Korea. So Amazon, the TV they sell for $400 bucks might be $300 bucks on this other site. Amazon is in for competition. So it’s an issue of timing. Timing is [relevance 00:53:53.9].
What’s another question?
Interviewer: Okay, which country or business healthcare model do you feel is the most innovative in bringing the financial and patient wellness outcomes efficiency, and why has this model been able to achieve this outcome?
Respondent: That’s a good question. The most innovative, I think, now, from a healthcare perspective, is the United States. The US the best in healthcare. With the innovations that they create, with the inventions that they do, nobody can compete in the US when it comes to this, right? That’s why everybody that’s ill and needs the best service comes to the United States. But that’s the innovation aspect, right? So they’re very innovative.
The entrepreneurship aspect, taking this innovation, turning it into a viable business in the entrepreneurship, in the entrepreneurial venture, the US is not doing a good job of this, right? Because of the current structures that they have, they can’t translate this into something more viable.
One of my earliest [unintelligible 00:55:01.6] in here, [Derby] Car Manufacturers in the US, right, they have to add on at $1,500 worth of healthcare benefits. So look in Korea and Japan, when they’re manufacturing a car, they’re a little bit ahead because they don’t have to pay $1,500 work of healthcare costs, but that’s something that the steel industry, the car industry, the automobile industry in the US have to incur. So innovation exists.
Entrepreneurship does not exist. So Sweden, I think, is very entrepreneurial in the sense of how they do their healthcare, but it’s all relative. They charge 47 percent worth of taxes. So, you know, think of it that way. Look at Canada, but Canada has a long wait time to be seen. The Netherlands is a good one, as well.
What’s another question?
Interviewer: Okay, I think we have time for one more. So it’s a statement with some questions. I attended a conference where a talk was given by a CEO of one of the local malpractice companies. He related a story of an EMR company who refused to pass on a patient’s charts that were in the EMR system, and when a practice decided to switch to another EMR to be [compliant 00:56:20.9] with the ACA Meaningful Use stages. Do you know of anything being done legally, or through the government, to protect physicians from actions like this?
Respondent: Yeah, okay, so this is a very good question, and it’s also, this is how American businesses are very smart. The word he used, EMR, Electronic Medical Record, correct? That’s the word being used, correct?
Respondent: So EMR is a medical record of a system, of the database or the service that’s being used. Okay, so it’s actually the property of that system, right? So, okay, if he doesn’t want to share it, it’s part of his system, or her system, therefore, they have rights on it, but if you just switch the word around from EMR to EHR, Electronic Health Record, then it’s the rights of the individual. Every patient has a right to obtain their electronic health record, not their electronic medical record. Electronic medical record can fold in a hospital, within a physician and clinician, and so on, but electronic health records, it’s the rights of that individual.
So if I was in this conference, I’d be like, can you please explain to me the difference between EMR and EHR, or electronic health records, and have you asked this company to provide you with all the electronic medical records in the form of electronic health records? And the debate switches because if it’s not in the contract saying, you know, if you hold my data, part of this contract is I need to have ability to download all this data, in a database on a system that I can give to the patients of their electronic health records, right? So now it’s contract. Now it’s business lingo. Exactly what did you buy, and what did you want to return, and in what format?
It’s kind of like you buying a subscription to a website to host your company and you don’t need the fine print, but the day you say, okay, I’m not using it anymore, the day you no longer have access to your content, well, if you were business savvy, or if you were business ready, you would say, fine. I’m going to use your services, I’m going to lease your services, but the day I switch, you need to provide me with all this content in this specific format so I can create something that is called portability. EHR should be portable across different hospitals and clinicians.
Electronic medical records, even though now we’re in the process of trying to create a uniform taxonomy, it’s difficult because everyone thinks that they have the best one. All right, but EHR should be systemized, and that’s what I think the government is doing in that sense, saying, what is a uniform EHR system? Or that’s what I’m hoping for.
Interviewer: Okay, I do think we have time for one more question. I am an engineer with a people management, nonprofit and pharma background. I’m ready for a career change, looking to start a healthcare consulting business. My interest is truly helping physician practices because more efficient ultimately producing measurable patient outcomes. Will this program help me do this?
Respondent: Yes, in three different ways. The first one is, if you’re an engineer that means you’re always going to talk numbers, right, and you’re going to try to figure out things from a financial or analytical perspective. Show me the numbers. Show me how I can put this in a systematic or systems approach. So this program will say to you that’s great, that’s a great skill to have, but it’s not only about numbers, it’s always also about the business. So tell me how you’re going to market yourself. Tell me how you’re going to figure out HR issues. Tell me how you’re going to figure out leadership issues, the finance issues, the accounting issues. Some of these numbers are going to come easy because it’s just part of your nature, being an engineer. So that’s just the business side of it. And so you’ll learn how to talk the language of business, how to put a proposal together, how to talk about, you know, what kind of law suits or different things about legal systems that you need to understand, and corporations of sorts.
That’s one part, which I call the CBK. The other part, which is the electives, right, you said you wanted a career change, so a lot of it is a little bit introspective and kind of who you are and what’s your mindset like. So you might want to take the Innovation and Creativity course. You might want to take the Social Entrepreneurship course. You might want to take some policy courses, right, and you might want to get into some courses that you have some passion for just to get you to be more artistic, all right, kind of like this side I’m saying here. So that will give you a little bit of a soft approach to it. So that’s one opportunity.
The second opportunity here, you said you were an engineer. I just mentioned one of the courses that we’re putting together is Lean Six Sigma, which comes from the engineering field. So imagine that you can potentially tap into this whole new growing realm or growth area of Lean Six Sigma and saying, I come from an engineering background. I should be looking into this and seeing how I can apply it to the healthcare industry. Again, when I say it’s the business of healthcare, well business involves engineering as well.
And finally, if you’re ready for a change, then you’re looking for outlets, so this is potentially one outlet that you should look into. So have fun with it.
Interviewer: Okay, great. I wanted to thank everyone for joining us today, and thank you, Dr. Tarabishy, for taking the time to speak with us. In the next few days, your dedicated enrolment advisor will be following up with you to provide the link to the recording. In the mean time, if you have any other questions regarding the program, or the application process, please feel free to reach out to them any time. Thanks again everyone and have a wonderful afternoon.
Respondent: Thank you. Bye-bye.