Rhoads: 00:04 Hi,
I'm Tom Rhoads, CEO of Spencer Health Solutions. We are fortunate to have Gil
Bashe on the "People Always, Patients Sometimes" podcast. Gil is a
Managing Partner of Global Health at Finn Partners, a global marketing and
public relations firm. Gil is a champion for health innovation to sustain life
and improve patient care. Gil has been tapped by PharmaVOICE as one of the
"100 Most Inspiring People in Healthcare" and that's just one of his
accolades. I hope you enjoy this interview with Gil Bashe on the "People
Always, Patient Sometimes" podcast.
Janet Kennedy: 00:37 Innovation is more than a buzzword to Gil Bashe. It's a lived experience through his roles with every kind of healthcare organization, including payer, provider, policy, pharma marketing, nonprofit boards, and even patient advocacy. Gil is on all the lists too. No, not that "Top 10 People on Twitter" list, but the lists like PharmaVOICE, "100 Most Inspiring People in Healthcare" or Fast Company's "50 People to Watch in the New World of Work". Phew! My name is Janet Kennedy and I am your host for the "People Always, Patient Sometimes" podcast, a production of Spencer Health Solutions. I'm thrilled to have Gil on the podcast. There's so much to cover. I think we'd better get started. Welcome to the "People Always, Patient Sometimes" podcast, Gil!
Bashe: 01:22 Well
thank you so much and I want to thank you and your sponsor for making this
possible. This is an important conversation. You know, often we're looking at
the process of innovation. We're looking at the fruits of innovation. At the
end of the day, it's all about trying to help people live longer, healthier,
better lives. And I think it's important that we always look at the origins of
what we do. It comes down to innovation, but it also comes down to how we
structure that innovation. And to that end, it's also about clinical trial
Janet Kennedy: 01:53 You know, I had to go back to like the '80s to find a time when you weren't the president of something. So you've been sitting in a big chair for a long time. You have experienced how many of these different kinds of organizations think at the highest level. So give us insight. I really want to try and understand what is the roadblock? Everybody talks about patient innovation and patient centricity, but you know, it's still a struggle to get folks to embrace it. So where do you think these roadblocks are?
Gil Bashe: 02:27 Well, let's start with the beginning of this. I've been privileged to lead amazing people through generations and a lot of what's driven the thinking process in each of these decades is economics. If we go back in time, we go back to the eighties and the nineties, we really weren't seeing expediential innovation. I think back to the eighties in the nineties we were dealing predominantly with small molecules. We were looking at treatments for hypertension. We were looking for treatments for cholesterol. We saw the advent of the treatments for depression, some treatments for asthma. But when we take a look at the giant leaps we've made in the last 30 years, the concept of immunotherapy for cancer, the concept of arresting ALS, these are relatively new ideas that are built on the foundation of those decades past. So on my part, I've consistently been a voice for bringing the industry closer to the advocacy community. So yes, on one half of my life I've been privileged to lead.
Gil Bashe: 03:33 I've had the title of executive officer. On the other hand, if you look at the other, the flip side of that CV page, I've had the privilege of being in leadership positions in patient advocacy organizations like the American Heart Association, like the Marfan Foundation, like the Galleon Foundation, like Let's Win for Pancreatic Cancer and other groups that had been advocating for the rapid acceleration of clinical trials and the voice of patients within those trials. So I've always seen myself as a bridge professional, not representing one segment or another segment, but trying to take a fragmented health system and bring it closer together. That's predominantly my personal mission is not to keep the sectors fragmented, but to understand that ultimately we all converge around the patient. The challenge is each sector has a different economic model, a different way it makes money. And because of that, each sector remains true to the borders that operate in.
Gil Bashe: 04:34 That's not going to change in the near future. But what can change is our understanding that we've got to shift from a sense of the economics or fee for service world to the value equation. How do we help people live longer, better, healthier lives? And that goes back to the inherent question you asked, which is on the clinical trial side, how do we begin to redesign the clinical trial process so that we get closer to our inherent mission together? And how did the sectors actually, instead of being sort of separated from each other, how do they look to each other as allies, this world of convergence and begin to realize that if we can propel innovation forward faster and more cost-effective and reduce the burden of failure faster, we might actually be able to ultimately provide our biggest value to society. Live sustained costs reduced.
Kennedy: 05:28 Well,
I think faster is a word that makes some people uncomfortable, but let's face
it, even a fast trial is going to take many, many months if not years.
Gil Bashe: 05:39 Yeah. But I, I do want to point out that historically we looked at a rolling patient within clinical trial centers. We qualified them, they had to fit the trial design and we carried on trials for an extended period of time. And that's important because obviously the basic rule of medicine is "do no harm". We have to abide by that, but we have some illnesses that time actually is harmful. So if you take a look at diseases such as Lou Gehrig's disease, ALS, you take a look at diseases that move very rapidly. Pancreatic cancer. Time is not on the side of that patient community. In fact, what we consider the standard of care in Duchenne's disease and other illnesses that move rapidly, time is in fact the enemy. So, on the one hand, we need a well designed clinical trial. On the other hand, we really have to listen to the urgency of the patient community, which includes the caregiver.
Gil Bashe: 06:35 We've got to come to some other system and that is where the concept now of machine learning, of technology, of electronic medical records, are going to have to play out in the future. And I will give some examples today. Let's say the guys and girls system of health care, they have technology afoot. They have artificial intelligence. They can tell which of their patients may, in fact, be at heightened risk for colon cancer. They can tell potentially which of their patient community will be moving from type one diabetes potentially to nephrology. Do we wait until those people become patients with cancer or do we look at it in a whole different way? Do we begin to proactively reach out to those communities and invite them into trials because they have a heightened genetic risk? These are the questions we need to ask. This is how we need to use technology.
Gil Bashe: 07:27 We can't wait until people have the disease. I think we have to begin to look at how do we invest in preventing the disease through clinical trial work. Clinical trials are going to take a lot of different perspectives right now and instead of looking at the patient as sort of like that "outsider", we have to bring the community inside. We often used to say, let's invite them to our table. It's always been the patient's table. We're invited to their table. We have to refine the value around their table. I think we have to take a look at them not in a paternalistic way. I think we have to take a look at them as really our compatriots and trying to deal with certain illnesses.
Kennedy: 08:07 Now,
do you think that the patients are really the ones that are driving this need
for innovation or is it because it's getting harder and harder to find patients
who fit some of these much more complicated disease states?
Gil Bashe: 08:21 Yes and yes. Yes and yes. It is harder to find patients, let's say in cancer trials it's harder to find patients because more and more companies are involved in more complex cancers and they're all competing for the same patients. That's one problem. And the other problem deals with how do we work with the communities to make sure that the communities actually are educating their patient community about what trials are available and how do they participate? How do we use electronic medical records more effectively to proactively move patients into those trials? We have the technology available. We've barely begun to scratch the surface of its potential. I do want to give some classic examples. Let's say you've sort of brought up the complexity of around chronic or rare diseases. We certainly have wonderful patient advocacy groups and these patients are in many cases being seen by systems or experts that deal with those chronic conditions.
Gil Bashe: 09:22 Patients actually in the end with some serious diseases tend to actually relocate and gravitate around centers of excellence. But we have no way of sharing these data. We have no way of accessing these data. We don't have interoperability of data in this country. It's a real challenge. The patient groups don't have access to them. In many cases, doctors within the same system don't have access to data. So it's going to make it harder and harder. We need to actually reevaluate or reinvent how we use data effectively. And that comes down to two elements that actually are often unspoken. One, data security. Who owns your data? If you sing a song, you compose a song and write a song, you own that song, you get paid for that song every time it airs on the radio. Who owns your data? Do you own it? Does your payer own it? Does your doctor own it? We've never resolved that question. That's one question. And two, the security of your data. Until we determine who owns your data and how we protect your data, will people want to contribute their data for the greater good? Now the data show the more severe the condition, the more eager the patient or the family is to contribute the data and that's very important. People say for the sake of science, I'll think about it, but for the sake of survival, there is little to think about. It's all in. So we as a society really have to deal with some fundamental issues. We have to protect patient privacy, we have to protect data security and we have to have a uniform national policy about these.
Gil Bashe: 11:03 Many nations do, and I'll give you a classic example. In my travels around the world, one of the most popular nations in the world to acquire data from, to do baseline studies for clinical trials is Israel. It's a closed-loop. The medical system has two or three payers that are locked into hospital systems and physicians, but they have complete interoperability. Another example I would say in this country actually comes from a small state, so moved to Israel is a small country, the state of Rhode Island, but governor of Rhode Island is an innovator in creating statewide interoperability of patient data and these states or these countries that do that probably will be the front runners in supporting biomedical innovation. So it's not one or the other. I think we have to look at our processes of how we respect data in order to accelerate how we do clinical trials
Kennedy: 12:01 How
do patients really understand how to manage, and access and understand their
own patient data. It's great to say that I should have it, but I struggled as
logging into my patient portal.
Gil Bashe: 12:13 Wow, that's exactly the case. You've nailed it. You really have nailed that and I support you on that. In many cases, patients don't understand what data they have. Many patients do, many patients don't. But you've just touched on one of the biggest problems of one of the nations in the world. That's one of the biggest innovators of clinical trial development or certainly new molecules, the United States. We do not spend sufficient time at the medical level educating patients on why their participation in their medical records is so important. And I do want to give an example. I don't mind sharing this. I have a daughter with a rare disease and it was finally diagnosed after years of investment in some of the best physicians for these symptoms in the country. When one doctor finally said, a doctor of note said, "I don't know what's going on".
Gil Bashe: 13:07 So part of it is the fragmentation of our health system where we tend to treat symptoms rather than a probe to the underlying root cause of what is causing that symptom. The fragmentation of our sectors and the fragmentation of our system on the patient communities. Inability often to understand how critical their data is to their own sustainability and to biomedical innovation creates barrier after barrier after barrier. It's not a sector that's creating a new barrier and it's not actually a financial incentive that creates the barrier. It's actually that we have so much fragmentation of our system that even within that same hospital system, we are often unable to communicate. And I'll give a classic example. I wrote a piece not too long ago called "Death by Facts", the true story of my mother's death and a major teaching hospital where two luminaries of medicine are unable to communicate rapidly with each other because their computer systems do not link up.
Gil Bashe: 14:11 And so one doctor is waiting for their notes to be typed up so they can be faxed, which is the HIPAA approved way of transmitting data to another doctor. And that delay resulted in the severity of my mother's situation. So to your point, it's not only that the consumer doesn't understand the immediacy or urgency around their data. In many cases, our system has built-in obstacles such as the government recommends the preferred way of transmitting personal data, your data, is by secure fax. What system uses fax to rapidly communicate our system? Obviously the root cause of innovation or clinical trial development is always going to be both. What data we can access, what data can we generate, how fast do we access it? How fast can we generate it? How fast can we interpret it? How fast can we utilize it? Those are basic obstacles. They're not obstacles to science. There are obstacles to process.
Kennedy: 15:18 It
also sounds a little bit like it's an obstacle of having enough mathematicians
and statisticians and people who understand analytics to be able to interpret
Gil Bashe: 15:29 This is a basic inherent challenge that I think this nation is going to face and that is actually our knowledge of STEM, right? So knowledge of science and technology and engineering and mathematics. This nation is falling behind. Now, fortunately, many of our drug development companies have a global perspective. They're tapping into talent all around the world, but at the bottom line, there are many clinical trials. We have X amount of centers of excellence that can participate or drive those trials and they have X amount of expert clinicians that can unravel and interpret the data and that is a rate-limiting factor. No, I think what we're talking about is the wow factor of the study. Right? I don't want to paraphrase what you're saying, but I think a "Wow study" such as the Wall Street Journal last week reported sort of like limited but important from a Mass General, very important data about ALS and ALS trial that shows great promise.
Bashe: 16:34 Now
that's because Mass General has a Center of Excellence around ALS and they were
interested in the hypothesis around that trial. This is a challenge. This is a
challenge. How do we entice Centers of Excellence to engage? I think it's going
to result in new clinical trial models. There are certainly world-class experts
that are talking about this. You probably know Craig Lipset, formerly from
Pfizer's clinical trial innovation team. He really I think is one of the great
thinkers in and really encouraging people to look at the clinical trial process
very differently than what we currently have, virtual clinical trials. How do
we use electronic medical records to actually look at sort of like free trials?
I do think that the clinical trial system is actually going to evolve very
rapidly in the next two to three years and how we educate the American
consumer, how we educate physicians, how we educate payers and providers in
participating in innovation. That's going to be a really a great challenge
Kennedy: 17:36 I
think one of the things that we're really excited about at Spencer, is the idea
that finally getting some feedback. Finally getting that sense that they are
creating C level and senior level to look at innovation, to look at new ways to
do trials. The challenge is going to be are the folks writing the protocols aware
of those innovations and build them in from the very beginning or are these new
innovations being tacked on, added on, modified?
Gil Bashe: 18:07 I think that what you just said in terms of what Spencer Health Solutions is doing is very important. This is an organization that is not only championing innovation, but they're also looking at the talent or processes that will be needed to support that poll environment and so Spencer is serving a greater role than just the clients that serve. It's, it's creating models that other enterprises are clearly going to have to look at and so it's a bellwether organization. I think we're wise to look at organizations like Spencer and others and say, where are they going? How do we model after them? Why are they going in that direction? And I think it does help all of us, whether people are engaging Spencer directly or not, and they probably should. What happens is when we start to look at organizations like Spencer, we start to realize that they can be very helpful in getting us to reevaluate the systems we're using, to begin with.
Janet Kennedy: 19:02 I want to go back to the patients a little bit and talk about health literacy, not just from the standpoint of writing in plain language, but actually educating our US citizens on how the health system works and even how your body works. You know, we've had so many push backs on simple things like sex education in middle school. I think we've sort of glossed over the whole thing of teaching people in a formal educational setting about how their bodies work.
Gil Bashe: 19:33 Yes, that is a challenge. First of all, I think that we have unfortunately gotten a very confused or mixed message around talk about biologically the miracle of us and it, no, it truly is a miracle. We're sort of walking, talking, thinking test tubes, chock-filled with chemicals and it is important for people to understand that at all different levels. So I completely agree with you. I think you're really touching something that is so vital, so important in terms of understanding this, but also understands that without taking care of ourselves that body does break down and that's where medicine plays a stronger role. And ideally, when I think back toward the 70s or sixties I often say to friends, why is it that Medicare kicked in at 65 or social security kicked in at that point? Because the basic life expectancy of people in our nation when these vehicles of retirement and national health were created was about 70 -72. You retired at 65 you had a few good years, you got sick and you left this world and that was a comprehensive understanding that you had a few good years of which to kick back and enjoy. Now, of course, we're looking at extending life expectancy out into the late eighties and nineties and we see more and more medical practices that are specializing in centurions a hundred-year plus. How often do you hear people leaving this world at 103, 104? It's common today and that's the miracle of medicine and also our perspective of trying to help people live longer lives. I don't want to say longer, better lives always, but certainly longer lives. We have to focus on the longer, better, healthier lives and that requires education.
Gil Bashe: 21:24 You know, I often find that we have a system in the developed world that is based on 'sick care' and by that I mean we access the system when we're not well, we're sick. We have to actually think about a self-care system that we nurture ourselves or those we support to be healthy. And that would be a healthcare system, but I think it's an oxymoron to call our system a healthcare system.
Gil Bashe: 21:52 I think people would, if they listened to our podcast today, and I want to thank you for this, they would realize we've built a sick care system. You go into the doctor's office not for preventive care or for counsel, to your point to learn about your body or to learn about how to be healthier, you usually have a symptom or a complaint that's concerning to you or to someone in your family and you access the system. So if the system is a sick care system, that's a fee for service system. As long as we incentivize the system to do stuff to us, has a proposed to prevent stuff from happening to us, we're going to continue to have a sick care system. We don't invest in all of the tools for healthy eating, for exercise, for choosing good foods, to understand how to read the food label, to how do see an illness at the earliest stages so that we can intervene.
Gil Bashe: 22:46 We have a society that has become addicted to sugar, that has obesity, not because it's genetic always, but because it is actually behavioral. They're two different things. All of this is contributing to cost and to illness, to sickness. I couldn't agree with you more. You know, I think it's a very backward system and I don't think that medicine is the answer to that. I actually think trying to get down to the granular level as you suggested, and educating the consumer to be their own best advocates, self-care, you know, the fact that we need clinical trials for more and more medicines is great for innovation. I think it would be better if we actually warded off sickness.
Janet Kennedy: 23:30 Excellent idea. With all of this innovation coming into healthcare, how do you think that impacts the primary care provider? I mean, in essence, they should be the hub of our healthcare. They're the first organization we see the most person that we would go to when we're not feeling well. Do you feel like they have a grasp of their role in the larger healthcare ecosystem or are they literally just trying to focus on the six patients, 10 patients an hour?
Gil Bashe: 24:01 Well, you're touching on a very thorny issue, demise of the primary care system. So for the most part in metropolitan areas, we have moved to an Amazon prime like model. For people who live in metropolitan areas when something presents, because we have a sick care system who's going to wait for three or four days to get into their primary care doctor if they're concerned about something. Few people. We're so used to ordering something online and receiving it the next day by 12 noon, without shipping costs, that has permeated our sense of healthcare. So how has the system responded to that behavioral shift? Well, in New York City you have walking ducks clinics or mini mergers or doc in a box, CVS, Walgreens, Walmart are actually inserting in many of their pharmacies, nurse practitioners, physician assistants, all hooked up to medical systems. They have telemedicine. And so what's happened is, the primary care physician, the person who was once the coordinator of your care is starting to diminish the sense of primary care medicine is being relegated now to other professionals.
Gil Bashe: 25:14 And so you, you and me, we're our own health historians now, aren't we? We have to remember our healthcare. When you go into a walk-in Doc, they don't ask you for your entire health history. They want to know why you're visiting today. It's like a dry cleaner. "How can I help you?" It's a service-based industry. Entrepreneurial. Okay, so primary care is, is actually evaporating to specialty care and that has led also. So the loss of the big question. Why? Why do you have that? So now I moved to since it's Walk-in Doc, I treat the symptom. You've got a rash, I treat the rash. You have a cough. I prescribe an antibiotic. We're moving to symptom-based care, not healthcare. And that's why Walgreens, has said they're going to put 1,500 clinics inside there. Heavy traffic, Walgreens. That's why Walgreens has doctors.
Gil Bashe: 26:12 I was in the UK two weeks ago. I walked by a pharmacy. What does the pharmacy say, doctor onsite 24 seven even in the UK? So primary care medicine is starting to sort of like become antiquated. It's not. And as a result of that, the person who wants coordinated care or was our advocate is no longer there. You and I need to be our advocates. That's why I said earlier in our conversation about clinical trials, why the patient advocacy community really has to step to the plate because they're the composite archivist or historian for all of that patient community's data, and I'll just give an example. Let's take a look at arrhythmia, very common irregular heartbeats in this country. There are very clear guidelines that state, how do we treat people with irregular heartbeats and yet only 30% of the people with irregular heartbeats with arrhythmias are treated to the guidelines. That means 70% are not treated to the guidelines, which also means in terms of stroke risk, they're not treated and that results in added costs to the system. It's not that we don't have medicines that would effectively help those patients deal with the potential of a clot. They just don't have an advocate for any law.
Janet Kennedy: 27:34 Wow. You know, my parents were good, solid, new Englanders with a long lifespan. My dad will be 90 in another week. My mom is 88. However, and I've always been fortunate. My mom is a retired nurse practitioner so I haven't had to be the healthcare advocate except now she's starting to lose some details and I realize I know nothing. I have their medical power of attorney and I know nothing about all the meds they take on a day to day basis. So over Christmas, we're going to have a sit-down and they're going to tell me what they are taking.
Gil Bashe: 28:11 Fantastic. You know this is so important because it's not a question of their acuity. It's a question of their partnership because there come times where they will need a strong voice and I see this constantly and so this is all part of one conversation, which is the voice of the consumer. We're not patients by the way. People have a health concern. We talked about arrhythmia. They're not people with arrhythmia. There are people who have never arrhythmia. We used to once upon a time say diabetics, do you remember that time? We said now we would never do that. There are people with diabetes, there are people! Even, by the way, people who are blessed to have age under their belt are people. And we all need support just like young people. People in elementary school need often a teacher support or a principal support or parental support.
Gil Bashe: 29:09 We always need support in our professional careers, we call it mentors, but in life, we call it people who care about us. People who care about us need to be brought into the tent and occasionally we feel very secretive about the fact that we're vulnerable. While we've been vulnerable, since the creation of time, we've been susceptible to disease, we've been susceptible to the environment. We need to have a support community and as we've grown and we've moved away, once upon a time it was places of worship or it was the family or it was children. As children and moved them away from their parents that people have moved away from community institutions, suddenly we are left adrift. Ideally, electronic medical records would be that life raft. Unfortunately, it doesn't connect to anything. Lack of interoperability. So I would say, Janet, your desire to be there for your parents are sturdy New Englander parents is the right way to go right now because we don't have systems in place that can protect their interests. You're their frontline advocate.
Kennedy: 30:24 Well,
and there's no training for that either.
Gil Bashe: 30:26 No, there isn't. And I think you're sort of like talking about "Everything I needed to know I learned in kindergarten"? I would say the basic rule of thumb is to treat others as you'd want to be treated. Be kind to others. That's the best thing we can do in business and in life. Treat others as we would want to be treated. Be kind to everyone. And I'm, I'm very fortunate that you know, my career started on the health care providers side since we talked about my sort of long career. It wasn't always as a leader of enterprises. It started as a caregiver. My career begins as a paratrooper combat medic, caring for both friend and foe alike. Understanding the basic responsibility of the human vessel as precious. And I think that we have to reclaim that understanding in each of us that each human being is unique and precious. We're part of a large echo system called the planet and we must do our best by each other. So it's not just a question of you're advocating for your parents. Every caregiver, every healthcare provider in an institution that they might find themselves has to say to themselves if this were my parent, would I feel I was giving them the same excellent care? If the answer to themselves is no, they better get cracking because it's not a job. It is a mission.
Janet Kennedy: 31:53 Oh Gil, you have really spoken to my heart here. I'd love to keep talking with you. We need to wrap up the conversation and I love wrapping it up on the idea of be kind and do unto others as you would have them do unto you. It's about health. Yes, but it's also about care.
Bashe: 32:13 Absolutely.
And I want to thank you and Spencer for making this conversation possible. Very
important, very valuable. And I wish you all great success.
Kennedy: 32:23 Thank
you so much, Gil. I appreciate you being here for "People Always. Patients