Tag: medicine



When Dr. Jeffery Davis, an emergency room doctor at Missouri Baptist Medical Center and 2017 Olin MBA alum, went on vacation with his family to sunny San Diego, he expected a break from the chaos of the ER. Instead, he spent his last day saving the life of a young man in the harbor whose leg was nearly amputated by a boat propellor.

On March 26, Dr. Davis and his family boarded a whale-watching boat at the San Diego harbor. They had a great trip, sighting a whale and a pod of dolphins. On the way back into the harbor, though, the boat captain noticed something concerning: a nearby vessel had thrown three people from the boat, and the third passenger being pulled back onto the boat had a severe leg wound. His leg had been nearly amputated at the knee, severing a major artery.

Faced with this gruesome scene, Dr. Davis’ medical instincts and level headedness kicked in. He jumped onto the boat and used his belt to create a makeshift tourniquet for the young man’s leg. The bleeding slowed, allowing time for the boat to dock and the young man to be loaded into an ambulance.

After nearly 20 years of experience in emergency medicine, Davis explained to the St. Louis Post Dispatch, that this kind of quick response is “hard-wired into you” and part of “who you are.”

After the incident, Dr. Davis and his family spent the rest of their last day decompressing and letting his three daughters to process what had happened. Then, they returned home to St. Louis, where Dr. Davis continues to treat severe injuries at Missouri Baptist Medical Center as an emergency room doctor.




Dr. Ezekiel J. Emanuel presenting his keynote address at Olin

Some disagreed on the way to fix rising prescription drug costs. Others differed on the priority non-medical social interventions should receive in the healthcare system. Others didn’t see eye-to-eye on the medical efficacy of expensive proton beam therapy in treating cancer.

But one theme drew universal agreement in Olin Business School’s healthcare symposium, a Calhoun Lecture Series event held on January 23: The US healthcare system is broken, bloated and bound for change.

The morning-long symposium drew a standing-room-only crowd of students, alumni, local industry leaders and faculty that spilled from Emerson Auditorium into Frick Forum to hear two panel discussions, plus a keynote address from industry rock star Dr. Ezekiel J. Emanuel, whose credentials extend from private sector medicine to government policy and into medical academia at the University of Pennsylvania.

Emanuel launched his talk by noting that US spending on healthcare—$3.5 trillion in 2017—was greater than the total GDP of several major global powers, including the United Kingdom. Then he shared the “single most depressing slide about American healthcare,” graphing healthcare spending from numerous developed countries against the life expectancy of their residents.

“We are spending a huge amount of money and not getting any return on it,” Emanuel told the audience, showing how the United States has “fallen off the curve” against countries such as Japan, Switzerland and Australia, who spend considerably less on healthcare, while their residents live much longer.

Still optimistic about change

The problem, Emanuel said, is a chronic case of wasted spending on unnecessary procedures, inefficient care and “pricing failures” that reward providers for the wrong outcomes. Yet through it all, he said, “I’m wildly optimistic about the American healthcare system. And the reason is California wine.”

Mary Jo Gorman, board member Curavi Health, moderated a panel with Mike Kaplan, founder Altos Health; Blake Marggraff, CEO Epharmix; and Michael Kinch, associate vice chancellor at WashU.

Mary Jo Gorman, board member at Curavi Health, moderated a panel with Mike Kaplan, founder of Altos Health; Blake Marggraff, CEO of Epharmix; and Michael Kinch, associate vice chancellor at WashU.

He referred to the 1976 “Judgment of Paris,” a first-ever blind taste test in which California vintners shocked the wine world by prevailing over French wines. The lesson: US innovators can do anything they set out to do.

“Every country is looking to the United States for innovation in financing and innovation in care,” Emanuel said. He cited four areas of focus that would move the industry in the right direction.

  • Value-based payment or bundled payments. Rather than the existing “fee-for-service” model, bundled payments would put patients and insurers on the hook for a “unit of care”—e.g., a hip replacement—with the costs integrated and later divvied up among individual providers. The model would incentivize providers to better coordinate care and cut unnecessary costs.
  • Deinstitutionalization and shifting care. Years ago, Emanuel said, the United States saw about 171 hospitalizations for every 1,000 patients. That’s down to about 103 in 2017. “We’ve shifted a lot of our care and we’re going to shift more of it out of the hospital,” he said, and those changes include the trend toward “minute-clinics” in drug stores and the reduced reliance on physicians in favor of nurse practitioners, physician assistants and virtual medicine.
  • Chronic disease management. Eighty-six cents of every dollar spent in healthcare is spent on on chronic disease management. Emanuel cited the example of Texas’ Rio Grande Valley, where half the population is afflicted with diabetes. The community has developed specialty clinics and aggressive outreach to the community. “The key to care management is active outreach—not waiting for them to show up sick.”
  • Behavioral health integration. “We have been isolating psychiatry ‘over there.’ Records are different. Billing is different. Bad, bad mistake,” Emanuel said. “You can bring down healthcare costs by treating co-morbid depression and anxiety” that accompanies many physical disorders.

Other interventions

After Emanuel’s talk, the audience heard from two separate panels, the first looking at “disruption in treatment” and the second focusing on “innovation in delivery methods” for healthcare. Below are a selection of moments from the program.

On the social impacts to health. Blake Marggraff, CEO of Epharmix, spoke about an incident involving a review of patients suffering from chronic respiratory disease. “There were some conversations that turned from, ‘Are you breathing OK?’ to ‘Sure, yes, but I’m also having trouble paying my rent this month.'”

Bart Hamilton, Olin's Robert Brookings Smith Distinguished Professor of Economics, Management & Entrepreneurship, moderated a panel with Mike Long, CEO, Lumeris; Steve Miller, CMO, Express Scripts; and Sandra Van Trease, group president, BJC Healthcare.

Bart Hamilton, Olin’s Robert Brookings Smith Distinguished Professor of Economics, Management & Entrepreneurship, moderated a panel with Mike Long, CEO, Lumeris; Steve Miller, CMO, Express Scripts; and Sandra Van Trease, group president, BJC HealthCare.

On technology and the need to better engage with individual patients. Mike Kaplan, founder of Altos Health, spoke of working with a “company that developed software allowing physicians to reach out individually to patients. The patients were engaging in this conversation with the physician and we were able to catch things earlier—lack of return to functional status, pain issues, infections.”

On drug prices. Emanuel said government regulation was the only solution. Steve Miller, chief medical officer at Express Scripts, said it could come to that, but there are intermediate steps that could allow the market to work. “Americans will try everything before they’ll try the right thing,” he said. “I’m a big believer in market-based solutions to drug pricing. The science is spectacular; the question is, is America willing to pay these prices.”

WashU’s Michael Kinch was a bit more blunt: “The pharmaceutical industry is the most efficiently self-immolating industry I’ve ever seen,” said Kinch, associate vice chancellor and director of the Center for Research Innovation in Business at the Institute for Public Health.

On spending: “America doesn’t have a money problem, it has a waste problem,” Miller said. “Healthcare is a tax on every single product in the country. When it’s 18 percent of GDP, everything is being taxed…America wants personalized care at public health prices.”

On access to healthcare: “Only about 50 percent of Americans have a primary care physician with whom they work,” said Sandra Van Trease, group president, BJC HealthCare. “Many receive care via phone—so developing trust happens differently. Being consumer-centric in how we create access is key.”

Mike Long, CEO of Lumeris, threw down the challenge for the next generation of business school students and medical professionals. “We have such a tremendously flawed system,” he said. “I’m hoping young people commit themselves to working in healthcare because they’re mad as hell and aren’t going to take it anymore.”

Pictured above: Dr. Ezekiel J. Emanuel presenting his keynote address at Olin’s healthcare symposium on January 23. He is vice provost for global initiatives, the Diane S. Levy and Robert M. Levy University Professor and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania.




By any measure, the education required to become a doctor is daunting: a 4-year undergraduate degree, 4 years in medical school, and 3-7 years of residency. The business of medicine is so complex, however, that many MDs are taking their education one step further.

In 2013, both Sheyda Namazie-Kummer, MD, and Vamsi Narra, MD, enrolled in Olin’s Executive MBA program. The goal? Gain a holistic understanding of the practice of medicine by mastering the business of medicine.

Sheyda Namazie-Kummer, MD

In her role as Director of the Clinical Advisory Group at BJC HealthCare’s Center for Clinical Excellence, Namazie-Kummer must regularly navigate new policies from the US Department of Health and Human Services and Centers for Medicare and Medicaid Services.

“There’s a mix of our integration of the clinical aspects of medicine and policy and the business aspects,” says Namazie-Kummer. “How do we deliver healthcare that is sustainable and high quality? Sustainability is critical for us.”

Narra, Professor of Radiology, Senior Vice Chair of Imaging Informatics and New Business Development, and Chief of Radiology at Barnes-Jewish West County Hospital, emphasized that understanding medicine as a business helps elevate its humanitarian goals: “As a physician, I am primarily trained in terms of taking care of patients, but having that business knowledge and being in the trenches, you see how you can contribute to the effort to get a better system in place.”

The business of medicine

Like any other business, medical practice requires a good understanding of where money goes and where it comes from. Narra said, “There is procurement and there are processes. You need to have a system to run the show (operations), quality and safety checks, a way to collect the revenue, and to negotiate contracts with the insurance payers or whoever else it may be.”

Vamsi Narra, MD

However, as a lifelong science student, Narra had not had much exposure to core business subjects like finance and accounting. Luckily, Olin’s EMBA program is rich with courses that explore the core aspects of business.

“Having an understanding of cost accounting gives me a sense of what to look into and what not. I don’t expect to be an expert in that area, because that’s not my area of expertise,” said Narra. “But when that is put in front of me, I can at least interpret those numbers and ask the questions so I can get more answers.”

Strategic planning and problem-solving

Namazie-Kummer expressed a similar appreciation for the EMBA’s breadth of studies. She saw the challenges in healthcare as business challenges—and wanted to learn how to tackle them.

“Broadening my understanding of the world of business and how the various aspects of strategic planning and operations come together, was just foundational in helping me better understand and appreciate some of the problems that we face in healthcare on a regular basis. Understanding the pieces has helped me effectively problem solve.”

Leadership development

For Namazie-Kummer and Narra, one of the most valuable aspects of the EMBA program was the focus on teamwork and effective management.

“You need to know every step of the way how to manage people,” says Narra. “Everyone is well meaning, but you have to figure out what the incentives are, how people react, what is human nature, and how can one become susceptible to the other kinds of information that is being thrown at them.”

When Narra talks to other MDs about pursuing the degree, he emphasizes the management aspect—and its additional time requirements. “For you to be an effective leader, you still need to maintain your core competencies. You still need to maintain your connection to your core team,” he said. “Even though I cut down on my clinical time, I still need to have my clinical time so I can understand the problems and challenges my teammates are facing. When you look at the situation overall, a physician leader actually has a lot busier schedule than a non-physician leader.”

Namazie-Kummer says the ability to manage and solve problems as a team, leveraging each member’s strengths, is critical to healthcare: “We can’t solve problems in medicine without operating as multi-disciplinary groups of people—not just doctors.”

Why MDs should consider an Executive MBA

Namazie-Kummer advises other MDs to keep an open mind about the EMBA if they decide to do it. “You can apply the skills you learn through an EMBA in so many different respects—you don’t have to just focus on something like finance. Remember that there are leadership skills and interpersonal interactions and group dynamics and strategy and so many other pieces that are as important as any one economic concept.”

“I realized as we finished the MBA,” Narra said, “that there’s not a single course that I did not find useful.”