Rebuilding trust in the patient-physician relationship in the digital health era [PODCAST]

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Join Arti Masturzo, an internal medicine physician and health care executive, as she shares her insights on the challenges of digital health tools and their impact on the patient-physician relationship. Discover how the digital health revolution is affecting health care professionals and patients, and learn about new solutions to help rebuild trust and connection in the health care system. Tune in to this thought-provoking podcast to gain a deeper understanding of the potential benefits and risks of digital health tools in modern medicine.

Arti Masturzo is an internal medicine physician and health care executive.

She shares her story and discusses her KevinMD article, “Bridging the digital divide: How to bring trust back into the patient-physician relationship.”

The Podcast by KevinMD is brought to you by the Nuance Dragon Ambient eXperience.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Get CME for this episode by clicking on the CME link in the show notes. Today we welcome Arti Masturzo. She is an internal medicine physician and health care executive. Her KevinMD article is titled “Bridging the digital divide: How to bring trust back into the patient-physician relationship.” Arti, welcome to the show.

Arti Masturzo: Thank you, thanks for having me.

Kevin Pho: We’ll get into your article in a little bit, but first off, just briefly share your story and journey to where you are today.

Arti Masturzo: Awesome. So I’m a board-certified internal medicine physician. I am a health care executive. I went from practicing full time to getting into private equity pretty early, and then I have just been through a few private equity gigs, some successful exits, and publicly traded company experience. Most recently, I served at Humana for two years in a home health innovation role, and then came to CCS about eight months ago.

Kevin Pho: All right. So as a physician, how did you get into that private equity world?

Arti Masturzo: It’s a really great question. I just got lucky, and looking back, this is probably where I should have belonged. I went into medical school because that is the path that my family all naturally took. The reality is I like to fix, build, grow, and sell. That is how I’m hardwired, which is why even when I was practicing, you’ll see in my resume, I just started businesses, because that is just naturally what I really love to do, and my strengths. So what drew me to private equity was luck; what got me there is just that it’s my wiring.

Kevin Pho: Now, there’s a common perception that physicians in general aren’t the best business-minded people, right? So for some doctors who are interested in kind of a nonclinical role, or going into private equity, or just going into that business world using their MD degree, what kind of questions should they be asking themselves to make sure that they’re the right fit, the right person for that type of world?

Arti Masturzo: So the second question, are you a right fit? You’re a right fit for any corporate role; you just have to find the right corporate role. But your first question, let me track back a little bit. Your first question is advice to physicians, right, who want to go into this but don’t feel like they have business acumen. There’s a big difference between being interested in business, being good at business, and then being right for business. And I think what happens, and I myself consider myself guilty, is that I have so many bruises, Kevin, on my body from my first corporate role. And they were the best bruises. I deserved each and every one of them, because I came in cocky, because I was thinking, “Well, I’m an MD. I know this. I’m smart. I can figure this out.” And it’s not about intelligence or intellect in business. It’s about what people call softer skills; I would argue they’re the harder skills.

For being successful in business, it’s your ability to really, are you a strategic thinker? Most doctors are. Are you a problem solver? Most doctors are. Are you an execution-minded person? Most doctors are. We’re pretty high-achieving people. The question is all those other things that bring success, which are really about: Do you know your triggers? Are you self-aware? Can you connect? Can you build relationships? Can you communicate authentically and get your point across in a way that someone who doesn’t have medical training can understand? Because, and I myself am guilty of this, when I walked in, I was thinking, “I knew the business majors in college. I knew who they were. This can’t be that hard.” The reality is it is hard.

And so my advice is don’t go in cocky; go in humble. Take the time to respect their world. And what I mean by that is I went and got an MBA after I had sold my first business to a PE firm. I didn’t need to learn how to run a business. What I got the MBA for was to pay respect to the people who had done the work to get their MBA. I needed to speak their language. I needed to honor their work, their field, and to be able to talk to them in a way that made sense to them, as opposed to trying to be the smartest person in the room. So I think, all in all, go in humble. Know that you don’t know what you don’t know, which is hard for some physicians, because we’ve been trained to know. That’s how we rise to the top: We’re the experts. That’s probably the first thing that came to mind when you asked that question.

Kevin Pho: So does it require formal training? Would you say an MBA degree is necessary?

Arti Masturzo: No. I will tell you the MBA was helpful. At the first PE gig, I remember, I’ll never forget this, it’s so embarrassing, we were on a call and somebody said “P&L” and “EBITDA,” and I literally was like, “I have no idea what that is.” So I wrote the letter P, the letter N, and then the letter L, question mark, and for EBITDA, I wrote E-B-D-A, question mark, question mark. And so with the formal training, you have to get grounded in the language. You’ve got to be able to talk operationally, strategically, and from a finance perspective. You could have all the smarts, but you have to be able to speak the language. So if that takes an MBA, great. If you can get that by learning from a For Dummies book, then great.

I will say that the best training is OJT, and that’s what I mean by the bruises. It’s not that I wasn’t smart enough; it’s that I didn’t know what I didn’t know, and I went in thinking I could do it. My communication skills sucked. My ability to, frankly, be humble in a room really sucked. I felt like, “Hey, I’m the doctor, so I have to be the smartest person in the room.” I lacked self-control, self-regulation, all of those things. These folks that grew up in business have been learning since their first job out of college, so they’ve had conflict in corporate settings, they’ve had yelling matches, they’ve had all of this stuff, and they grew up in it, so they have it. We don’t have it, because the way that we were raised is very different.

Kevin Pho: All right, let’s talk about your KevinMD article now, titled “Bridging the digital divide: How to bring trust back into the patient-physician relationship.” Now, how did the article come together?

Arti Masturzo: So the article came together because the company that I joined, CCS, where I am now, was trying to solve for addressing the problem of diabetes and complex diabetes-related conditions in a specific patient population. And that patient population is those folks that are high-complexity enough that they meet the medical necessity requirements for a continuous glucose monitor.

So we went in, and we said, “OK, all right, how are we going to do this?” And the first thing we had when I walked in was a digital app, and I can’t tell you, my visceral reaction to it was just so strong that I just said, “Oh, this isn’t going to be a digital play. Digital’s great, but this cannot be a digital play. It has to be just a tool.” And then obviously they started getting like, “Wait a minute, we just got a chief medical officer for the first time, and she’s telling us that this great idea that we had isn’t great. So tell me more.”

And so the inspiration was really about, if you asked me what gets your blood pumping in the morning, at the heart of what you do, and this is going to come off a little Pollyanna and cheesy, so just bear with me, it’s bringing that humanity, love, and connection back into health care. And I think some of that, and why I say Pollyanna is because I’ve been accused of being a little idealistic, I think some of it comes from my upbringing in a developing country, in a village where my grandfather took care of folks in exchange for apples, right, or vegetables. They don’t have apples in that part of India, so it’s vegetables.

And so the way I think about it is that at the core of everything that we do, that physician-patient relationship is the thing that makes everything else go around. And so as I think about all the digital tools, think about all the things that are on the market today, right? What do they do? They go to the employer or they go to a health plan, and they say, “We’re going to fix your MSK. We’re going to fix your cholesterol. We’re going to fix your whatever.” Whatever that magic is, it’s effective. The problem is it goes straight to the member, or the patient, as you and I would call them, and you’ve completely left out the treating doctor.

And so now you’ve got a doctor who’s burned out, exhausted, spending most of their time charting, and we can go on and on and on, and now you’ve completely left them out of a very important treatment algorithm. Now you’ve got a patient coming in and saying, “Hey, my app told me I should be doing this. You told me to do 10 sit-ups a day; my app says I need to do 10,000 steps.” I realize it’s a really ridiculous analogy, but to me, those conversations, and I still practice, so I still have them, can be demoralizing, because what you want to say to the patient is, “I’m doing my best. Trust me, and let me help you, and let’s work at this together,” because everything else around us is utter chaos. And so that was really the inspiration for the article.

Kevin Pho: So when you brought up your reservations and gave that practicing clinician perspective to the technology team, what happened next? How did they accept your feedback?

Arti Masturzo: Amazingly well, and I can tell you from past experiences that’s not how it always goes. Now, some of it, Kevin, is that I have gotten very smart and learned how to say something when I don’t agree with it. So some of it is the inner work that I’ve done in making sure that I’m communicating from a place of my values and authenticity, and always with the mindset of doing the right thing for the company. So some of it is that, but honestly, it’s the company culture. When you have a CEO that’s like, “Hey, we’re changing, we’re transforming this company, and we’re going to hear some things that are uncomfortable,” what that did is it gave me the permission space to have that authentic conversation. So I was very lucky, because the tech team said, “Tell me more.”

Kevin Pho: Great. Now, you said that that type of feedback and the response isn’t as common. So give us a glimpse into this health tech world, because I know a lot of them do have physicians as CMOs, and they share their experiences. So in general, what is the norm for these tech companies that provide tools to both physicians and patients, and what’s their general acceptance of that practicing clinician input?

Arti Masturzo: It is so variable. It is just so all over the place. And frankly, when I joined CCS, one of the conversations I had was, “Can I not have a chief medical officer title? Can we come up with, like, chief pooh-bah officer or chief pookie, like anything but medical?” Because the problem is that the CMO role can look like you’re running a P&L, or like you’re a figurehead, and that spectrum is really, really broad.

And so what I would say is that for this role, I’ve been fortunate to have a lot of mentors in my life, a lot of just really good sponsors and mentors, and I had an hour-long video call with Jack Welch. This was several years ago, and we were talking about careers and development, and he was talking about me, and we talked about what I like to do and my strengths. And he said to me, and I’ll never forget it, verbatim, “Companies hire CMOs as figureheads and for credibility, to keep them out of trouble. Don’t ever let that happen to you.” It is hands down the best advice that I’ve ever gotten.

So I would say that, depending on, listen, some doctors don’t mind that. I’m not wired that way. And so for me, as I think about career opportunities: Do I have a seat at the table? And I don’t mean like a dinky little side-corner kiddie table. Meaning, are the important decisions being made that impact revenue, growth, compliance, and operational metrics, and am I a key decision-maker in those things? If I’m not, I’m out. I don’t have to be in charge. I don’t have to be a number two. You can give me any title, but I want to make sure as a physician that the soul of health care really gets into the company, because that’s, I think, a pretty big miss that we have right now in the tech world.

Kevin Pho: So I’m interested in hearing your perspective about these digital health care tools in general. What’s your assessment of the current landscape, and where do they fall short?

Arti Masturzo: So first, I will start: I’m a big believer in not calling babies ugly, right? Because nobody’s solution is perfect, and everybody’s trying their best. In my two years at Humana, I got a lot of vendors pitching digital tools, right? “We’ve got an app.” “We can text.” I had one company that was like, “We have emojis and animals that can talk to patients.” You name it, there’s a gamut, right? And the challenge is, where is the physician in this? Where is the connectivity in all of this? Where is the accountability, the reporting infrastructure, the information sharing to show that this is in fact valuable?

So I think there’s a question of not necessarily efficacy, because once you get a member engaged, a patient engaged, these things work. I’ve downloaded a weight loss app, for instance, and I was able to lose weight on it, so these things are effective. So it’s not a question of efficacy, but when you look at effectiveness, you’re as good as the engagement that you get from the patient, and that’s where the variability comes in, and that’s where things fall short. Number one, you’re leaving the doc out. Number two, you’re not going to get everybody to use the app. At best, it’s in the 30s, probably. Some companies spend a ton of money and they get maybe into the high 30s if they’re really lucky, but then by a year, you’re down in the teens. So that’s the engagement. And then, can you keep them engaged? And then, can you truly show that it is your app that delivered value? Because it’s really hard to quantify that your tool is the thing that was responsible for lowering the A1C when there were all these other efforts around you. So I applaud the effort. I love that people are innovating. I do think that there’s a big picture that we’re missing with these tools.

Kevin Pho: So a lot of times, like, I’m an internal medicine primary care physician, and like you said, inundated with all these digital tools, and on my podcast I talk to so many health care executives who work for various health tech companies. So what makes one stand out from another? How can you increase adoption among physicians to use one of these digital tools?

Arti Masturzo: So what sets a good tool apart is, number one, the physician is incorporated, and that’s what my article is about. So I hope it’s OK that I keep sort of hammering that, because it’s something I’m passionate about. Number one, you didn’t skip over the doctor and take an already strained relationship and make it worse. Number two is you can show an ability to enroll, meaning that people actually use your app. Third, they stayed with you long enough to make the impact. And then lastly, quantify the impact and show me it was long-lasting.

Kevin Pho: We’re talking to Arti Masturzo. She’s an internal medicine physician and health care executive. Her KevinMD article is titled “Bridging the digital divide: How to bring trust back into the patient-physician relationship.” Arti, what does the future hold in terms of digital? What do you anticipate some trends to be?

Arti Masturzo: So in digital health, what I anticipate, and it’s already happening, I saw it when I was at ViVE just a few weeks ago, is we’re probably going to stop putting so much emphasis on the word digital and really start using more of the word multimodal, right? Meeting people where they are, as opposed to where we want them to meet us, right? So in the next five years, I see digital health morphing into more of a multimodal solution. I also see a lot of these tools incorporating behavioral health, mental health, and social determinants of health.

Kevin Pho: All right, and my last question: Tell us some of your take-home messages that you want to leave with the KevinMD audience.

Arti Masturzo: So the take-home message for clinicians out there, practicing, not practicing, in administrative roles, corporate roles, whatever role you’re in, is demand a seat at the table and make sure your voice is heard. We are where we are because we’ve relinquished control, and we let non-health care providers run what we, in our hearts and minds, have been trained to do, and now we have this. So let’s take it back. Let’s do it with love and intention and authenticity, with the patient in mind, but let’s get a seat at the table, any table, small table, big table, wherever you can, and make sure your voice is heard.

Kevin Pho: Arti, thank you so much for sharing your time and insight, and thanks again for being on the show.

Arti Masturzo: Thanks for having me. Take care.

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