Interview with Dr. Laura Clapper
In today's podcast, Dr. Laura Clapper joins us to discuss jobs in leadership roles with health plans and self-insured organizations, and how to best prepare for those positions.
Dr. Clapper is a seasoned C-suite executive with substantial experience developing value-based care, provider-health plan joint ventures, and digital health solutions. As a thought leader, she has concentrated on integrating analytics and cutting-edge technology into established systems.
Laura has held positions as a chief medical officer and medical director at a number of different national health insurers. And she is known for her work with organizations on team building, strategic planning, and employee health and benefit design. Dr. Clapper is dedicated to improving healthcare for consumers and businesses by making it more accessible, clear, and inexpensive.
She earned her Master's in Public Policy Analysis from Claremont Graduate University while completing her medical degree at the Uniformed Services University of the Health Sciences. She served 14 years in the Navy.
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Leadership Roles with Health Plans
There are numerous positions in Fortune 50 companies, including Medical Director, Contracted Physician Reviewer, and Physician Consultant. The entry-level positions are in utilization review and benefits management. With more experience, these jobs can lead to leadership roles with health plans.
Preparing to Work for Insurers
Insurance companies perform hospital-like credentialing. Therefore, physicians must be board qualified and remain so with an active license. Also, an active DEA in one of the U.S. states is often necessary.
Dr. Clapper highly recommends a book by Dave Evans and Bill Burnett called, “Redesign Your Work Life”. It can help readers think about their careers differently.
Networking and shadowing can also be very helpful. Laura describes ways to use those techniques for finding jobs and learning about them before committing to a specific one.
She also suggested completing the Certified Physician Executive (CPE) program through the American Association for Physician Leadership. She maintains that you do not always need a master's degree, but it can be helpful when pursuing certain positions. Taking business and management courses can be a good way to learn business principles and demonstrate commitment to advancing your career.
Summary
Check out Dr. Clapper's LinkedIn profile to learn more about her training and professional background. You can connect and message her there. She is trained as an executive coach and has been coaching physicians, so you can contact her if you are interested in those services. She has extensive experience coaching women physicians to help them assume leadership positions.
NOTE: Look below for a transcript of today's episode.
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Transcription PNC Podcast Episode 265
Pursuing Leadership Roles with Health Plans and Self-Insured Employers
- Interview with Dr. Laura Clapper
John: I'm really excited about today's guest because I want to learn more about managing and leading in the payer side of things. It's like a black box to me. Obviously as a CMO, my hospital interfaces with insurers and payers, but I really don't know how they work internally. My guest today has a lot of experience with very large, well known healthcare insurers. And so, with that, I'd like to welcome Dr. Laura Clapper to the podcast. Hi Laura.
Dr. Laura Clapper: Hi John. I'm so excited to be here. We've talked about doing a podcast together almost since you got started. So, I'm really excited to be here today and share about payers and self-insured employers.
John: Excellent. This is going to be very useful and I am going to learn as much as you my beloved listeners today because it's again, something I know very little about. I'm glad you're here. Why don't you tell us a little bit about your background and clinical training and so forth? It is a long list of things. I do have a separate intro that includes most of those, but anything you want to tell us today that would be helpful to get us started.
Dr. Laura Clapper: Sure. I think it's interesting, at least to me, when we talk about an early career path is that my father was an entrepreneur and was in the aerospace industry and really dealt with satellites. And so, I worked with him when I was in middle school, late elementary school through high school till I went to college. And he did AI and was known for pattern recognition. His patents, he helped develop the barcode for Fred Smith at FedEx. He worked on for Hughes for Digital TV.
But the point that I'm getting to is when I went to college, the idea that we could use AI and algorithms data to really improve healthcare was really what got me excited about medical school and going into healthcare. And the Dartmouth Atlas had come out a couple years before that. And so, this idea we could use data to figure out was more hysterectomies happening, one town versus the other and some of the initial Dartmouth Atlas work. I just got really excited about that. We could use data and dashboards to improve care and look at patterns and have algorithms and really leverage technology. So, I think that's a different path than most people take going to medical school. And so, that's why, and if you look at my career, it really did influence the kind of work I've done and kind of the projects that get me really excited.
John: Well, healthcare was behind in terms of implementing a lot of the technology that other businesses implemented. As physicians and being involved with the health provider hospital, boy, it was just interesting to see with patient safety and quality, the ability to measure things and then risk adjust, and then put systems together to find patterns, as you said, and try and use them to improve safety and care. It's just been really fantastic in the last 20 years. So, it sounds like you were right where you needed to be, if that was what your interest was.
Dr. Laura Clapper: Yeah, it's interesting. Because as physicians, we know patients are not the same. They have different genetics, different environment. Their families are different. What they want to get done and their values and kind of what they hope for themselves in the future are different. And so, we really have to think about each patient differently. That's where I think early on clinical practice guidelines and this is the right way on care really didn't take into account patient nuance and we're getting much better at understanding and be able to do risk adjustment and compare patients to patients so we can have cohorts as well as starting to bring in social determinants of health.
John: Now, one thing I would mention to the listeners is you were also in the Navy. I think for 14 years. So, I'm not sure if a lot of that learning was while you were in the Navy or before, during, after. But when you talk about leadership and management, of course, there's a lot of lessons learned there I'm assuming.
Dr. Laura Clapper: Being in the Navy was great and going to the Uniformed Services University, the military medical school. We actually work with the public health service also. It was important in terms of thinking in a much broader way because there's a huge system trying to provide care globally and trying to figure out can someone stay on their ship and get care through the mid-level who's on the ship and get consults over the phone or does the person need to be flown off? Is the person able to stay in the Middle East or do they need to come back for care at a medical academic center in the US? So, all those things were brought into our training.
John: Very interesting. Well, the thing that impressed me or at least caught my attention was the time that you spent at these large national insurers. My listeners are mainly interested oftentimes in finding jobs that they're not really aware of. So, what kind of opportunities are there in working for these insurers? Maybe just tell us your story in terms of what you were doing. And as we go along, just kind of some hints how they might be able to follow a similar trajectory.
Dr. Laura Clapper: I'm a pediatrician. I'm board certified and primary care. And I think that ensures, there's multiple. We think about Anthem, Cigna. I was at Health Net. That's now part of Centene, in Aetna. So, I've been at some really large employers that are insurers. And it's not one job there. And I guess that's my main point. There are multiple jobs.
These are companies that are under fortune 50 or bigger. And they have jobs where they are leadership team jobs, where you're having multiple medical directors work for you. You may have jobs where you're working more quality and clinical practice guideline development. You may be working with pharmacy, researching, pharmacy drugs, and working with the pharmacist and maybe doing support work for either running or being a support staff person for the pharmacy and therapeutics committee or doing pharmacy. You may be sitting as a specialist.
If you're someone who's a neurosurgeon, an oncologist, someone who's doing a lot of more expensive, orthopedic surgeon or back surgeon or anything like that, you, there may be opportunities in the insurance companies where they're doing prior authorization. And that would be something. Even Aim Specialty, Evercore, they're now owned by insurance companies.
So, your job in those roles would be looking as people are requesting back surgery, maybe multiple levels and you're looking against the clinical practice guideline to see if you can approve it or if you have questions then doing it peer to peer. Usually in those situations, you'll have a team of nurses that are reviewing. So, if the person clearly needs it, it gets to approve it as fast as possible. And so, it'll get approved. The health plans are even working. So, if you put all the information in, it could be like auto approved, then it would go to if a clinical team member could approve it. If it's still not meeting criteria, then it's going to go to especially matched physician who can review it and either potentially deny it or say that there's questions or things like that. So that's prior authorization and it's similar too for pharmacy. You need to match up to the specialty.
Also, there's an inpatient review. So are they meeting InterQual or Millman clinical guidelines and working with the discharge planning. Are they going to go to staff? Are they going to go to an assisted living facility? Are they going home? They need a home house. So, working with the nurse care teams on coordinating the care and discharge planning, and connecting them in with their primary care. So, there's physicians who do those roles.
John: Now let me jump in there just to help clarify. I'm assuming that many of those might be called physician advisors. In the hospital side, working in a hospital, usually if you're doing any kind of that benefits management or clearance, it's a physician advisor. Although I could imagine that might also be a medical director role if you have more experience, maybe you're supervising a clinical team, would that be right?
Dr. Laura Clapper: Yes. In the health plans or the insurance companies, we would call them medical directors.
John: Okay.
Dr. Laura Clapper: They might be associate medical director, assistant. There are different titles, but basically a medical director would fall into that category. You may be working with a big team. You may have some people, that the early listeners may have done some work as case-by-case work or per diem, like they're covering certain days for an insurance company.
But the medical director role is really working on that coordination, responsible for complex cases, review, quality review and working across the team with the nurses, the medical directors, and probably some contracted physician reviewers and the contracted or per diem physicians may be called physician consultants. They may be advisors, but usually once you're a full-time employee, you're called medical director.
John: All right.
Dr. Laura Clapper: And I do want to clarify, to be in that role, the insurance companies actually do credentialing similar to a hospital. So, you need to be board certified and currently board certified. You need an active license. It doesn't have to be in every state, but in one of the US states, you have to have an active license and you need to have an active DEA. Usually, you can have a waiver for hospital privileges, similar to primary care where someone else is covering you. They're not expecting going to the hospital, but you need to have quality discussions and represent your specialty as someone who's a respected expert.
John: Got it. Yes. Because you're having those conversations with the attendings and the surgeons and so forth. So, you need to be able to talk to their language and have some authority, it sounds like.
Dr. Laura Clapper: Right. Correct. And I think that's important because people think about them as nonclinical jobs. So, some of the sad stories I hear are people who didn't renew their board certification, or they let their license lapse and then they want to come work for the Health Plan because they see it as being nonclinical. And I have to talk to them about how can you go renew your license because you can't be in a clinical job at Health Plan or insurance company without being... Because you're the clinical voice, internal and external. So you need to have qualifications to really be able to be an expert.
You'll hear about physicians who are not, but you actually need to look for nonclinical jobs at those health plans. So, an example would be if you also knew technology and you wanted to be like an engineer at the Health Plan and you were clinical, but you let things lapse, you wouldn't be able to work as a physician at the Health Plan. You would have to actually take on a sales role.
John: Okay.
Dr. Laura Clapper: Or I know somebody who's a physician, who's actually at Anthem, who's in contracting. But he doesn't do anything as a clinical voice in the company. He actually does all contracting.
John: Got it. Now, are there other jobs that are outside of let's say the utilization and benefits management, those kinds of things within these large industries?
Dr. Laura Clapper: Yes. And so, some of the other roles that people take on would be working in innovation and technology. You would think there'd be a lot of those, but it's actually pretty small. And usually, the health plan wants you to have a day job to work on those. So you may be doing UM and for a nephrologist who may be kind of leading the idea around, or is the expert around nephrology and doing some UM and other things, working on clinical practice guidelines and then working with the technology team on what's needed to support chronic kidney disease and dialysis and act as an expert in that area may work with the contracting team that's working with the large dialysis organizations, providing clinical expertise around his or her specialty. So, you start to be kind of the SNE in that clinical subject matter and area.
Some of the other ones that you and I've talked about is self-insured employers. Usually in the large insurance companies, there's national accounts, sometimes there's strategic accounts, but usually they fall under the clinical support for the national account team. And then you're working with self-insured employers. And most self-insured employers may have some insured pieces and some self-insured, but their primary product is self-insured.
And usually, you work in a team. You're working with a team of clinical consultants, really experienced, excellent nurses who will go out and work in a more frequent manner with the self-insured employer and then you're being their consultant. And then you're going to the client meetings, maybe their annual meeting or for really large employers you may be going like every couple months. If they're like in the top 10 employers for that health plan, they're going to get higher level service and included in that is having a physician consultant that is assigned to you. And you're their person or their medical director.
John: Okay. I'm going to clarify something too. I'm trying to understand this. The employers are self-insured, but they have a relationship with the payer or the health insurance, because they're actually managing the claims. Is that why there is that partnership?
Dr. Laura Clapper: Well, it's a good question. And so, the self-insured employer usually has a broker or consultant. So, think about Towers Watson or you'll have Aon or other kinds that will be helping them coordinate their health benefit package.
John: Okay.
Dr. Laura Clapper: And so, they'll have that team member or consultant, and then you have the health plan. Now employers will sometimes, especially if they're a large employer, will have multiple health insurance plans working with them. Some they want to give a choice. So, they'll give a choice. They may say we have like in California, it's pretty common. You'll have Kaiser and another health plan.
John: Okay.
Dr. Laura Clapper: And then if their employees wanted HMO, they'll go with Kaiser. If they want PPO or some form of PPO, they'll go with the other health plan. Sometimes they'll offer HMO in both with Kaiser and the other insurance, but they'll have a combination. So, you'll see different insurance companies with one employer. But that tends to be a lead insurance company that either has most of their employees that they work with. And they'll tend to coordinate among the three. The self-insured employer, their consultant, and kind of their lead health insurance company will kind of work on when it's going to be open enrollment. What changes are they going to make to their benefit plan? Are they going to change their deductible level? What are they going to need to do to be able to communicate to their employees? What's coming? And everyone works together with that.
When I first started doing this, which was 25 years ago when I first went to Health Net in 1997, none of the employers really had their own chief medical officers unless they were a health-related company. If they were a health system and we were providing their insurance, then they might have a chief medical officer come. But otherwise, they didn't.
And the medical part of the service that the health plan was providing was to have a medical director who would explain clinical questions or if someone was upset, why they couldn't get a surgery, because it had been denied under prior auth. They would act as a second opinion in some ways to kind of look like not that you were that in that specialty, but you want to say like, "Was the process followed correctly?" You might talk to someone about if they had questions about what their appeal rights were. So, you wouldn't change anything, but if you saw something when you went through it, like, "Did you have all the faxes when you made your decision? Because I can see these facts that got maybe added the next day and you might have not seen it or something like that."
So, you would look, was there integrity to the process and then talked to someone to kind of explain what the process is and what are your next steps if you're going to appeal. So, you could play both roles as a physician being kind of like the speaker of truth. Having taken the Hippocratic oath, you're there trying to represent that. I think over 25 years that more companies are hiring their own chief medical officer that would come and sit in the company and represent the companies. I think a lot of times the national account medical directors act as the medical director for the employer, but there is an uptick and I think COVID also increased the chief medical officer that they're being hired by self-insured employers.
You see Delta hiring chief medical officer, other larger corporations because they need someone to be looking at, "Do we have the right procedures in terms of personal safety hygiene? How close can the seats be? Working with the industrial hygienist, OSHA and occupational medicine team and facilities team trying to figure out. And so, they've gone and hired a chief medical officer.
And what I just said about COVID might've sounded like that's crazy to have a medical director working with these different people. But when I was at Cigna during most of the COVID pandemic, we literally were talking to people, working with facilities to pull the diagrams, to look at ventilation, to say, could people be in those parts of the building? What do we know? Could we do something to upgrade the filtration? Because we had people that need to be providing pharmacy or we have the Cigna medical group in Arizona where they are safe in their buildings and were their patients safe and what could we do? So, the medical directors of the plans do get involved in those things. But I definitely keep hearing different large organizations hiring chief medical officers.
John: I guess that leads me to the question on both sides of that equation, both for the insurers themselves and for these large corporations. What kind of preparation can you do if you're practicing and you're deciding, "Okay, maybe that sounds interesting to me. How do I prepare myself or position myself for applying for a job? And where do I look for these jobs? Do I start with the insurers? Do I think about going directly to an employer at this point and try and map that out?" So, there's two questions for you to try and hit.
Dr. Laura Clapper: I really believe there's a book that I really like. I've actually read it twice and I would recommend it. It's called "Redesign Your Work Life" by Dave Evans and Bill Burnett. They wrote "Redesign Your Life" early on. But their big thing is think about like three paths, think about and prototyping. So, I would say to someone who really wanted to get involved with the self-insured employer, maybe there's a large employer in your town. Maybe go figure out how you could talk to them about do they have a need, see what they have going on? Does it fit with what you like to do to go and maybe look at their factory safety data or something like that? Talk to HR people who are talking about insurance. Is that something you're interested in?
So usually there's networking and asking questions, learning about it would be part of prototyping, figuring out if you could go for a day, maybe a tour or follow someone along. Is this something you like? Talking about this is reminding me of someone I know who was thinking about coming to insurance plan and actually went and spent one day with one of the medical directors that I really loved when I was at Anthem.
And after one day she said, "I don't want to be sitting there doing this. I like talking to patients." That kind of blew her. She was like, "No, I don't want to do it." Because she really saw what it was like. So, I think the more you prototype is you try things out and see. Maybe you're just looking. There are jobs where you could be 50-50. When you're not doing 100%, maybe you would love doing patient care. And so, maybe you don't have to decide. It's not like "all or nothing." Maybe you can figure out if you decrease your hours sum and do some case reviews or do some other kind of work with an employer in your town that you can do a combination.
John: Okay.
Dr. Laura Clapper: And maybe that fit is going to give you a lot of satisfaction, being able to do both. And other people might say, "Heck, now that I can do this, I feel like I'm done seeing patients." So, I think if you can figure out ways to test, to maybe take time off work and go do something for two weeks, try to do some ways you can test out your theory, you can get a better idea. Those kinds of questions, do you like working with those different kinds of teams? What do you like? What brings you joy?
John: It is a challenge and I never used to bring up this idea of shadowing as a way to find out about a job. Partly because sometimes it's difficult. Some companies will not allow that because it's HIPAA or proprietary information and this and that. But boy, if you can actually spend a day with somebody and see what the job really entails, that's going to give you some really awesome insights. So, I do now bring that up from time to time as an option. But like I say, I get pushed back from my listeners and others who say "They won't let me do it."
Dr. Laura Clapper: I think you have to be careful, like the instance I've talked about, the person was with one of the ACOs. So, I think in terms of cross training and understanding how they could work together, there was a reason, it wasn't just like randomly showing up. There was like a paperwork trail of meeting together. So, I think you're bringing up some really important points and you just can't randomly go and sit and listen to PHI. There needs to be good boundaries.
John: But if you're working in a hospital that happens to be, have an insurer or a payer that is providing their coverage. Well, then that would be potential in. It's sort of like when you're in practice and you're prescribing medications. You have a salesperson and that salesperson can connect you with the MSL who might then be able to tell you about what they do or even have you join them on occasion. So yeah, you have to be a little more creative I guess and look at what would be the best way to develop that relationship and then have that opportunity.
Dr. Laura Clapper: That's a good point though. If you're in a hospital, you could go and talk to the HR team and say, "Could you listen in on and do a networking interview? What kind of issues did they have? How do they plan about the insurance coverage for the hospital, particularly for the employed staff. So, it tends to be nurses, less physicians, but the employed staff. Could you listen in on a meeting?"
Usually in meetings between the insurance companies and an employer, you wouldn't talk about PHI. It'd be more things like how is the medical cost running, how much proportion the budgets spent for complex high-cost patients versus wellness and other kinds of costs. How are you doing in terms of HEDIS measures that are your mammogram rate, your immunizations for under five, your adolescent physical visits, where you look at the HEDIS and that's a big part of when you're working with the plan and self-insured employers. It's really looking at how's the total plan running, not just on cost, but quality of care.
John: And that's something to research when you're actually applying for a job. So, you kind of know what's going on. And so that's something that we talk about a lot. Things are obviously evolving. Are there certain jobs you think are in more demand now than let's say five years ago that we can kind of look forward to and anticipate some need growing in these areas?
Dr. Laura Clapper: Yes. Several different areas. One is I think telehealth roles are expanding. When I was at Anthem and we were working with live health online, which is kind of a white labeling of Amwell, you could have a small group supported. Now there's a much bigger component with COVID of care and the whole care model. You start to see medical groups that are having telehealth services. And I think everyone's trying to struggle how do you provide good longitudinal care and that satisfaction from both the provider and the patient, as well as provide better extended hour access, make sure someone really needs to drive in and park and do everything to come in just to say, "Oh my incision looks better." And we can do that through a telehealth visit that's better for everyone, yet, if you're in practice and you're trying to make your practice run well, and you have staff who are checking people in, check doing the receptionist, do all these things, it's difficult to do a telehealth visit and have your staff overhead be sitting there and not having things to do.
So, if hear people saying, well, they're taking certain half days to do telehealth. You're doing half days. And do you share your office now? Do you add more providers into the office planning because they're taking these half days of doing telehealth visits? If your patient needs to get seen, are we doing more of a group practice and not really individual PA provider practices because we're trying to do both telehealth and in person? Do we have parts of medical groups who just like we have hospitalists now they become the telehealth docs?
They put their notes into the electronic health records. So that's more connected than urgent care is to primary care because you're part of the same group. That you could actually then see in the electronic health record, the primary care visits, the telehealth visits and any ER hospitals visits. So, you could see care that way.
So that's good. But I think we're struggling, how do you do the most efficient manpower with providing this hybrid telehealth, inpatient care? And so, I think there's going to be jobs coming out of that as we rethink that whole care model. And what's the best for hybrid care? And at the end of the day, I think patients want to know that you know them, that they have a relationship with you, that there's trust. And that's what I love about primary care. That you know them, you know the family and I think this is a challenge for us. How is medicine going to be practiced in the next even five years? How do we create a system so we get the care we want to have and we want to have for our parents, our families?
Because not that long ago, physicians were practicing in their communities where they'd go to the grocery store, they'd go to the church, they'd be in community organizations. Their kids were in school. And they would know a lot of things about the community. Like the plant was closing down, there's a new employer coming into town, or there's been clacks in the last week and this family was impacted. You knew things about your patients because you were part of that community.
And now we are practicing a lot of times away from the community. We're on telehealth or we're covering different hospitals, or we're doing different things like that. And so, we don't really know the patients in the context outside the visit, like we did in the past. And I think that impacts our decision making or how confident we feel in our decision making.
To me in the future, we're going to have to figure out how to bring that context. And that's really where we start talking about social determinants of health, knowing more about your patients, knowing do they have housing insecurity? What's happening? Is their daughter bringing their food? Do they have food insecurity? Because they're struggling because the plant closed. Like what do you know about them? And when it's just becoming more as a systemized way to approach people that we used to kind of just know because we knew that family.
And when I think about this whole trust in knowing I hate it. When I go and I have to call someplace and you have to verify yourself multiple times. You put all this security information, they say, okay, and they pass you on and they want it again. I hate that. It feels really inefficient. I feel like you should know me. And I think patients feel like that. They feel like why I have to tell my story to so many people. I'm always trying to think, how can we know people, have a good handoff, make it efficient for the patient?
And I do tie this back to what your question was of where's the jobs in the future. Because there's going to be all those jobs, having a strong care team, a strong care model and who are going to be the physicians who are working on building that, whether it's data, technology. Epic has a big influence on us. Epic and Cerner.
John: Exactly.
Dr. Laura Clapper: When all physicians are sitting around talking about Judy pajama rounds and how they have to do extra hours doing their epic and closing their charts, I'm really a big believer that in the next 10 year... Well, I hope everyone's laughing when they're hearing that because it's really influenced physician's lives or families and everything. It's good having the documentation and you can go anywhere in the system and know if someone needs a mammogram.
That's great, but it's come at a cost. And the cost has been unevenly born by physicians at doing all this documentation that hasn't been taken into account. So, my hope is in 10 years, we have a different addition, whether it's a disruptor in the EHR space or they've evolved with Oracle acquiring Cerner. So, it is not with Scribd, but we actually have a better system.
I think that's just one way where I think there'll be jobs and technologies, especially for people who've practiced a long time because they know how it works and they know how people use electronic health records. They know how to use their phrases and can set it up. And people who are really good at being efficient in the EHR, they did EHR since medical school and residency and things like that. There's a huge gap. And so, how do we close that gap so everyone can be good at it? And I think better technology will do that.
I think that we'll start to see more physicians working with startups and independent boards and advisors with startups that's still growing, even with what's going on with the stock market and venture capital. I think this is kind of a pause, but I think that mostly more of that biotech and biosimilars, genetics, all these areas are growth areas, cellular therapies. They tend to be focused on certain specialties in certain areas. And if you're one of those, that's great, but I think there'll be more roles in those areas also.
And one of the things I pursued during the pandemic was actually working on getting my executive coaching certification. And I think we're going to see more physicians as executive coaches too in all different ways. More working on the team, maybe across the hospital. That would be my hope and dream that we really see physicians as an important part of the leadership team in health systems and having them play that role of being executive coach, be actually executive coaches with different executives, as well as other kinds. I think working as an executive coach/advisor at startups or other kinds of ways where you see executive coaching brought in. And so, I think there's a lot of different roles that will come out in the future.
John: Awesome. That's a good overview. When you were talking, I was thinking back to when hospitalists were first introduced and you talk about not knowing the patient. And then telemedicine another example. And so, how somehow the technology has to bring this all together. And then as far as the coaching, I had a physician once. He was a pretty stodgy old man like me. He was like, I don't get it with all these physicians becoming coaches. And it was just funny because business people have used coaches for years. In fact, I have a friend who requires that. He won't take a job unless they're going to give him a business coach.
And so, physicians are left to wander and learn on our own. It's like, that's not good. So, mentors and formal coaches make sense. I'm glad that you're getting involved in that. And especially executive, when you combine physician and executive roles, that's not something that's easy to navigate when you have no background in that. Even if you get an MBA or something, it doesn't teach you how to be a physician executive by any means. So that's fantastic. Well, we're going to run out of time here. Anything else you want to add to what you've already told us? Give us a glimpse and some ideas to shoot for potentially.
Dr. Laura Clapper: I really like what you said about the executive coach and having physicians who are taking on leadership role, even if it's short-term coaching for their first 90 days or for transition in the role. Other roles on the executive team are having coaches. I think as a physician, I wouldn't even have thought to ask for one. And I think we kind of have to increase our awareness and our negotiation into thinking about that. But you and I also talked about other categories. So there's cellular therapies is more combination around the pharmacy and biosimilars, and I think there's going to be a big change, especially with this inflation reduction act of how pharmacy is going to change. And I think there'll be roles for physicians in that as well as with the medical clinical liaison roles. But I think there's also these roles about how pharmacy and PBMs are going to work because they're going to be changing. And the value-based insurance design and how physicians play a role with that.
But I think also women's health is becoming a big area. I just recently was the chief medical officer in FemTec Health and really thinking about how do we address the disparities in health for women. They have a much higher autoimmune burden in terms of incidents of autoimmune disease. And those diseases tend to take six to seven years to get diagnosed.
John: Yeah.
Dr. Laura Clapper: They tend to be more vague. And so, people don't really think about the autoimmune. So how do we create either pattern recognition or profile to help or earlier identification? I think it is really important. Think about endometriosis. It's a very underdiagnosed condition. People may show up in the ER and say they have abdominal pain. They are having fatigue, different things that are seen as vague issues. And then when they're trying to get pregnant, usually endometriosis starts to be diagnosed either by very heavy period or when someone has infertility issues and then they'll figure it out. So, I think we really need to start. And I think part of it is we don't code it. We don't diagnose, we don't code it. So, we don't find people who need the help early enough. And I think it's partly because we didn't think about electronic health records or other kinds of visit forms to even start thinking about asking the right questions. We don't ask the right questions so we don't think about it. The prompts aren't there. And so, it gets lost. The story I like to think about, they had the Apple watch, everyone loves the Apple watch. It took them actually a couple years before they even added the last menstrual period into the mix.
John: Oh, really?
Dr. Laura Clapper: It was more than two years. And even then, they don't have other kinds of questions. We might have a lot of data. We may have technology and devices, but we haven't really thought from the women's perspective first, how to bring these things together. And yet even the work that we're doing in terms of Medicare and Medicare advantage and all the boomers, the growth that we're seeing in Medicare. There's a lot of startups in the Medicare space. And yet who's in the Medicare space for most of the time? It's older women.
John: Yeah.
Dr. Laura Clapper: I think we're going to have to rethink the care and the guidelines for older women. So, there's lots of new kinds of specialties or areas that I think physicians can take their clinical knowledge and really pursue.
John: Yeah. I think we've probably both been exposed to people that are interested in AI and with AI you can recognize patterns. They're not necessarily markers. They're just like patterns of behaviors or background or exposures, which it's just beyond me. I don't even understand how you would capture all that and put it together. But almost to where it'd be like a dog that could sniff a cancer and something totally off the wall, but it'll get there eventually. So, there's lots of opportunities.
I know that our listeners are going to have a need or a desire to get in touch with you somehow. So, I know you have a LinkedIn profile. You're there and I'll put that in my show notes. Any other ideas of how they can find you? Is that the easiest?
Dr. Laura Clapper: I think that's probably the easiest. The other way is through the American Association for Physician Leadership. I think that if you're a member, you can link up with me or connect with me that way. I teach in the Capstone Faculty. That's actually another thing that I think is a good step towards if you're interested in a more physician executive career.
John: Absolutely.
Dr. Laura Clapper: If you are thinking about getting CPE, you can do it. You don't have to go get a masters. You can take the different courses at your own pace. And I think that I've found that people get a lot of benefit from that. I got a lot of benefit personally from it and I continue to see people learning and having that kind of peer group they can talk to.
John: Well, you're in that group like "Oh, I'm one of these kinds of people. I'm one of those that are doing this medical directorship or CMO role or whatever it might be." And anyway, your comment too is very good timing because I believe that the podcast either before or after this one is my interview with Dr. Peter Angood. You didn't know that, did you?
Dr. Laura Clapper: I didn't, but that'll be great. He will be a wonderful interview.
John: Yeah. He's great. All right. I think that we are over time now. So, this has been really fun, Laura, a lot to think about. And I really appreciate you for spending this time today with me and going through some of this. Maybe we'll have you back on some time down the road.
Dr. Laura Clapper: Thank you, John. Thanks for having me. The pleasure was all mine.
John: All right. You take care. Bye-bye.
Dr. Laura Clapper: Bye.
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Transcription PNC Podcast Episode 265
Pursuing Leadership Roles with Health Plans and Self-Insured Employers
- Interview with Dr. Laura Clapper
John: I'm really excited about today's guest because I want to learn more about managing and leading in the payer side of things. It's like a black box to me. Obviously as a CMO, my hospital interfaces with insurers and payers, but I really don't know how they work internally. My guest today has a lot of experience with very large, well known healthcare insurers. And so, with that, I'd like to welcome Dr. Laura Clapper to the podcast. Hi Laura.
Dr. Laura Clapper: Hi John. I'm so excited to be here. We've talked about doing a podcast together almost since you got started. So, I'm really excited to be here today and share about payers and self-insured employers.
John: Excellent. This is going to be very useful and I am going to learn as much as you my beloved listeners today because it's again, something I know very little about. I'm glad you're here. Why don't you tell us a little bit about your background and clinical training and so forth? It is a long list of things. I do have a separate intro that includes most of those, but anything you want to tell us today that would be helpful to get us started.
Dr. Laura Clapper: Sure. I think it's interesting, at least to me, when we talk about an early career path is that my father was an entrepreneur and was in the aerospace industry and really dealt with satellites. And so, I worked with him when I was in middle school, late elementary school through high school till I went to college. And he did AI and was known for pattern recognition. His patents, he helped develop the barcode for Fred Smith at FedEx. He worked on for Hughes for Digital TV.
But the point that I'm getting to is when I went to college, the idea that we could use AI and algorithms data to really improve healthcare was really what got me excited about medical school and going into healthcare. And the Dartmouth Atlas had come out a couple years before that. And so, this idea we could use data to figure out was more hysterectomies happening, one town versus the other and some of the initial Dartmouth Atlas work. I just got really excited about that. We could use data and dashboards to improve care and look at patterns and have algorithms and really leverage technology. So, I think that's a different path than most people take going to medical school. And so, that's why, and if you look at my career, it really did influence the kind of work I've done and kind of the projects that get me really excited.
John: Well, healthcare was behind in terms of implementing a lot of the technology that other businesses implemented. As physicians and being involved with the health provider hospital, boy, it was just interesting to see with patient safety and quality, the ability to measure things and then risk adjust, and then put systems together to find patterns, as you said, and try and use them to improve safety and care. It's just been really fantastic in the last 20 years. So, it sounds like you were right where you needed to be, if that was what your interest was.
Dr. Laura Clapper: Yeah, it's interesting. Because as physicians, we know patients are not the same. They have different genetics, different environment. Their families are different. What they want to get done and their values and kind of what they hope for themselves in the future are different. And so, we really have to think about each patient differently. That's where I think early on clinical practice guidelines and this is the right way on care really didn't take into account patient nuance and we're getting much better at understanding and be able to do risk adjustment and compare patients to patients so we can have cohorts as well as starting to bring in social determinants of health.
John: Now, one thing I would mention to the listeners is you were also in the Navy. I think for 14 years. So, I'm not sure if a lot of that learning was while you were in the Navy or before, during, after. But when you talk about leadership and management, of course, there's a lot of lessons learned there I'm assuming.
Dr. Laura Clapper: Being in the Navy was great and going to the Uniformed Services University, the military medical school. We actually work with the public health service also. It was important in terms of thinking in a much broader way because there's a huge system trying to provide care globally and trying to figure out can someone stay on their ship and get care through the mid-level who's on the ship and get consults over the phone or does the person need to be flown off? Is the person able to stay in the Middle East or do they need to come back for care at a medical academic center in the US? So, all those things were brought into our training.
John: Very interesting. Well, the thing that impressed me or at least caught my attention was the time that you spent at these large national insurers. My listeners are mainly interested oftentimes in finding jobs that they're not really aware of. So, what kind of opportunities are there in working for these insurers? Maybe just tell us your story in terms of what you were doing. And as we go along, just kind of some hints how they might be able to follow a similar trajectory.
Dr. Laura Clapper: I'm a pediatrician. I'm board certified and primary care. And I think that ensures, there's multiple. We think about Anthem, Cigna. I was at Health Net. That's now part of Centene, in Aetna. So, I've been at some really large employers that are insurers. And it's not one job there. And I guess that's my main point. There are multiple jobs.
These are companies that are under fortune 50 or bigger. And they have jobs where they are leadership team jobs, where you're having multiple medical directors work for you. You may have jobs where you're working more quality and clinical practice guideline development. You may be working with pharmacy, researching, pharmacy drugs, and working with the pharmacist and maybe doing support work for either running or being a support staff person for the pharmacy and therapeutics committee or doing pharmacy. You may be sitting as a specialist.
If you're someone who's a neurosurgeon, an oncologist, someone who's doing a lot of more expensive, orthopedic surgeon or back surgeon or anything like that, you, there may be opportunities in the insurance companies where they're doing prior authorization. And that would be something. Even Aim Specialty, Evercore, they're now owned by insurance companies.
So, your job in those roles would be looking as people are requesting back surgery, maybe multiple levels and you're looking against the clinical practice guideline to see if you can approve it or if you have questions then doing it peer to peer. Usually in those situations, you'll have a team of nurses that are reviewing. So, if the person clearly needs it, it gets to approve it as fast as possible. And so, it'll get approved. The health plans are even working. So, if you put all the information in, it could be like auto approved, then it would go to if a clinical team member could approve it. If it's still not meeting criteria, then it's going to go to especially matched physician who can review it and either potentially deny it or say that there's questions or things like that. So that's prior authorization and it's similar too for pharmacy. You need to match up to the specialty.
Also, there's an inpatient review. So are they meeting InterQual or Millman clinical guidelines and working with the discharge planning. Are they going to go to staff? Are they going to go to an assisted living facility? Are they going home? They need a home house. So, working with the nurse care teams on coordinating the care and discharge planning, and connecting them in with their primary care. So, there's physicians who do those roles.
John: Now let me jump in there just to help clarify. I'm assuming that many of those might be called physician advisors. In the hospital side, working in a hospital, usually if you're doing any kind of that benefits management or clearance, it's a physician advisor. Although I could imagine that might also be a medical director role if you have more experience, maybe you're supervising a clinical team, would that be right?
Dr. Laura Clapper: Yes. In the health plans or the insurance companies, we would call them medical directors.
John: Okay.
Dr. Laura Clapper: They might be associate medical director, assistant. There are different titles, but basically a medical director would fall into that category. You may be working with a big team. You may have some people, that the early listeners may have done some work as case-by-case work or per diem, like they're covering certain days for an insurance company.
But the medical director role is really working on that coordination, responsible for complex cases, review, quality review and working across the team with the nurses, the medical directors, and probably some contracted physician reviewers and the contracted or per diem physicians may be called physician consultants. They may be advisors, but usually once you're a full-time employee, you're called medical director.
John: All right.
Dr. Laura Clapper: And I do want to clarify, to be in that role, the insurance companies actually do credentialing similar to a hospital. So, you need to be board certified and currently board certified. You need an active license. It doesn't have to be in every state, but in one of the US states, you have to have an active license and you need to have an active DEA. Usually, you can have a waiver for hospital privileges, similar to primary care where someone else is covering you. They're not expecting going to the hospital, but you need to have quality discussions and represent your specialty as someone who's a respected expert.
John: Got it. Yes. Because you're having those conversations with the attendings and the surgeons and so forth. So, you need to be able to talk to their language and have some authority, it sounds like.
Dr. Laura Clapper: Right. Correct. And I think that's important because people think about them as nonclinical jobs. So, some of the sad stories I hear are people who didn't renew their board certification, or they let their license lapse and then they want to come work for the Health Plan because they see it as being nonclinical. And I have to talk to them about how can you go renew your license because you can't be in a clinical job at Health Plan or insurance company without being... Because you're the clinical voice, internal and external. So you need to have qualifications to really be able to be an expert.
You'll hear about physicians who are not, but you actually need to look for nonclinical jobs at those health plans. So, an example would be if you also knew technology and you wanted to be like an engineer at the Health Plan and you were clinical, but you let things lapse, you wouldn't be able to work as a physician at the Health Plan. You would have to actually take on a sales role.
John: Okay.
Dr. Laura Clapper: Or I know somebody who's a physician, who's actually at Anthem, who's in contracting. But he doesn't do anything as a clinical voice in the company. He actually does all contracting.
John: Got it. Now, are there other jobs that are outside of let's say the utilization and benefits management, those kinds of things within these large industries?
Dr. Laura Clapper: Yes. And so, some of the other roles that people take on would be working in innovation and technology. You would think there'd be a lot of those, but it's actually pretty small. And usually, the health plan wants you to have a day job to work on those. So you may be doing UM and for a nephrologist who may be kind of leading the idea around, or is the expert around nephrology and doing some UM and other things, working on clinical practice guidelines and then working with the technology team on what's needed to support chronic kidney disease and dialysis and act as an expert in that area may work with the contracting team that's working with the large dialysis organizations, providing clinical expertise around his or her specialty. So, you start to be kind of the SNE in that clinical subject matter and area.
Some of the other ones that you and I've talked about is self-insured employers. Usually in the large insurance companies, there's national accounts, sometimes there's strategic accounts, but usually they fall under the clinical support for the national account team. And then you're working with self-insured employers. And most self-insured employers may have some insured pieces and some self-insured, but their primary product is self-insured.
And usually, you work in a team. You're working with a team of clinical consultants, really experienced, excellent nurses who will go out and work in a more frequent manner with the self-insured employer and then you're being their consultant. And then you're going to the client meetings, maybe their annual meeting or for really large employers you may be going like every couple months. If they're like in the top 10 employers for that health plan, they're going to get higher level service and included in that is having a physician consultant that is assigned to you. And you're their person or their medical director.
John: Okay. I'm going to clarify something too. I'm trying to understand this. The employers are self-insured, but they have a relationship with the payer or the health insurance, because they're actually managing the claims. Is that why there is that partnership?
Dr. Laura Clapper: Well, it's a good question. And so, the self-insured employer usually has a broker or consultant. So, think about Towers Watson or you'll have Aon or other kinds that will be helping them coordinate their health benefit package.
John: Okay.
Dr. Laura Clapper: And so, they'll have that team member or consultant, and then you have the health plan. Now employers will sometimes, especially if they're a large employer, will have multiple health insurance plans working with them. Some they want to give a choice. So, they'll give a choice. They may say we have like in California, it's pretty common. You'll have Kaiser and another health plan.
John: Okay.
Dr. Laura Clapper: And then if their employees wanted HMO, they'll go with Kaiser. If they want PPO or some form of PPO, they'll go with the other health plan. Sometimes they'll offer HMO in both with Kaiser and the other insurance, but they'll have a combination. So, you'll see different insurance companies with one employer. But that tends to be a lead insurance company that either has most of their employees that they work with. And they'll tend to coordinate among the three. The self-insured employer, their consultant, and kind of their lead health insurance company will kind of work on when it's going to be open enrollment. What changes are they going to make to their benefit plan? Are they going to change their deductible level? What are they going to need to do to be able to communicate to their employees? What's coming? And everyone works together with that.
When I first started doing this, which was 25 years ago when I first went to Health Net in 1997, none of the employers really had their own chief medical officers unless they were a health-related company. If they were a health system and we were providing their insurance, then they might have a chief medical officer come. But otherwise, they didn't.
And the medical part of the service that the health plan was providing was to have a medical director who would explain clinical questions or if someone was upset, why they couldn't get a surgery, because it had been denied under prior auth. They would act as a second opinion in some ways to kind of look like not that you were that in that specialty, but you want to say like, "Was the process followed correctly?" You might talk to someone about if they had questions about what their appeal rights were. So, you wouldn't change anything, but if you saw something when you went through it, like, "Did you have all the faxes when you made your decision? Because I can see these facts that got maybe added the next day and you might have not seen it or something like that."
So, you would look, was there integrity to the process and then talked to someone to kind of explain what the process is and what are your next steps if you're going to appeal. So, you could play both roles as a physician being kind of like the speaker of truth. Having taken the Hippocratic oath, you're there trying to represent that. I think over 25 years that more companies are hiring their own chief medical officer that would come and sit in the company and represent the companies. I think a lot of times the national account medical directors act as the medical director for the employer, but there is an uptick and I think COVID also increased the chief medical officer that they're being hired by self-insured employers.
You see Delta hiring chief medical officer, other larger corporations because they need someone to be looking at, "Do we have the right procedures in terms of personal safety hygiene? How close can the seats be? Working with the industrial hygienist, OSHA and occupational medicine team and facilities team trying to figure out. And so, they've gone and hired a chief medical officer.
And what I just said about COVID might've sounded like that's crazy to have a medical director working with these different people. But when I was at Cigna during most of the COVID pandemic, we literally were talking to people, working with facilities to pull the diagrams, to look at ventilation, to say, could people be in those parts of the building? What do we know? Could we do something to upgrade the filtration? Because we had people that need to be providing pharmacy or we have the Cigna medical group in Arizona where they are safe in their buildings and were their patients safe and what could we do? So, the medical directors of the plans do get involved in those things. But I definitely keep hearing different large organizations hiring chief medical officers.
John: I guess that leads me to the question on both sides of that equation, both for the insurers themselves and for these large corporations. What kind of preparation can you do if you're practicing and you're deciding, "Okay, maybe that sounds interesting to me. How do I prepare myself or position myself for applying for a job? And where do I look for these jobs? Do I start with the insurers? Do I think about going directly to an employer at this point and try and map that out?" So, there's two questions for you to try and hit.
Dr. Laura Clapper: I really believe there's a book that I really like. I've actually read it twice and I would recommend it. It's called "Redesign Your Work Life" by Dave Evans and Bill Burnett. They wrote "Redesign Your Life" early on. But their big thing is think about like three paths, think about and prototyping. So, I would say to someone who really wanted to get involved with the self-insured employer, maybe there's a large employer in your town. Maybe go figure out how you could talk to them about do they have a need, see what they have going on? Does it fit with what you like to do to go and maybe look at their factory safety data or something like that? Talk to HR people who are talking about insurance. Is that something you're interested in?
So usually there's networking and asking questions, learning about it would be part of prototyping, figuring out if you could go for a day, maybe a tour or follow someone along. Is this something you like? Talking about this is reminding me of someone I know who was thinking about coming to insurance plan and actually went and spent one day with one of the medical directors that I really loved when I was at Anthem.
And after one day she said, "I don't want to be sitting there doing this. I like talking to patients." That kind of blew her. She was like, "No, I don't want to do it." Because she really saw what it was like. So, I think the more you prototype is you try things out and see. Maybe you're just looking. There are jobs where you could be 50-50. When you're not doing 100%, maybe you would love doing patient care. And so, maybe you don't have to decide. It's not like "all or nothing." Maybe you can figure out if you decrease your hours sum and do some case reviews or do some other kind of work with an employer in your town that you can do a combination.
John: Okay.
Dr. Laura Clapper: And maybe that fit is going to give you a lot of satisfaction, being able to do both. And other people might say, "Heck, now that I can do this, I feel like I'm done seeing patients." So, I think if you can figure out ways to test, to maybe take time off work and go do something for two weeks, try to do some ways you can test out your theory, you can get a better idea. Those kinds of questions, do you like working with those different kinds of teams? What do you like? What brings you joy?
John: It is a challenge and I never used to bring up this idea of shadowing as a way to find out about a job. Partly because sometimes it's difficult. Some companies will not allow that because it's HIPAA or proprietary information and this and that. But boy, if you can actually spend a day with somebody and see what the job really entails, that's going to give you some really awesome insights. So, I do now bring that up from time to time as an option. But like I say, I get pushed back from my listeners and others who say "They won't let me do it."
Dr. Laura Clapper: I think you have to be careful, like the instance I've talked about, the person was with one of the ACOs. So, I think in terms of cross training and understanding how they could work together, there was a reason, it wasn't just like randomly showing up. There was like a paperwork trail of meeting together. So, I think you're bringing up some really important points and you just can't randomly go and sit and listen to PHI. There needs to be good boundaries.
John: But if you're working in a hospital that happens to be, have an insurer or a payer that is providing their coverage. Well, then that would be potential in. It's sort of like when you're in practice and you're prescribing medications. You have a salesperson and that salesperson can connect you with the MSL who might then be able to tell you about what they do or even have you join them on occasion. So yeah, you have to be a little more creative I guess and look at what would be the best way to develop that relationship and then have that opportunity.
Dr. Laura Clapper: That's a good point though. If you're in a hospital, you could go and talk to the HR team and say, "Could you listen in on and do a networking interview? What kind of issues did they have? How do they plan about the insurance coverage for the hospital, particularly for the employed staff. So, it tends to be nurses, less physicians, but the employed staff. Could you listen in on a meeting?"
Usually in meetings between the insurance companies and an employer, you wouldn't talk about PHI. It'd be more things like how is the medical cost running, how much proportion the budgets spent for complex high-cost patients versus wellness and other kinds of costs. How are you doing in terms of HEDIS measures that are your mammogram rate, your immunizations for under five, your adolescent physical visits, where you look at the HEDIS and that's a big part of when you're working with the plan and self-insured employers. It's really looking at how's the total plan running, not just on cost, but quality of care.
John: And that's something to research when you're actually applying for a job. So, you kind of know what's going on. And so that's something that we talk about a lot. Things are obviously evolving. Are there certain jobs you think are in more demand now than let's say five years ago that we can kind of look forward to and anticipate some need growing in these areas?
Dr. Laura Clapper: Yes. Several different areas. One is I think telehealth roles are expanding. When I was at Anthem and we were working with live health online, which is kind of a white labeling of Amwell, you could have a small group supported. Now there's a much bigger component with COVID of care and the whole care model. You start to see medical groups that are having telehealth services. And I think everyone's trying to struggle how do you provide good longitudinal care and that satisfaction from both the provider and the patient, as well as provide better extended hour access, make sure someone really needs to drive in and park and do everything to come in just to say, "Oh my incision looks better." And we can do that through a telehealth visit that's better for everyone, yet, if you're in practice and you're trying to make your practice run well, and you have staff who are checking people in, check doing the receptionist, do all these things, it's difficult to do a telehealth visit and have your staff overhead be sitting there and not having things to do.
So, if hear people saying, well, they're taking certain half days to do telehealth. You're doing half days. And do you share your office now? Do you add more providers into the office planning because they're taking these half days of doing telehealth visits? If your patient needs to get seen, are we doing more of a group practice and not really individual PA provider practices because we're trying to do both telehealth and in person? Do we have parts of medical groups who just like we have hospitalists now they become the telehealth docs?
They put their notes into the electronic health records. So that's more connected than urgent care is to primary care because you're part of the same group. That you could actually then see in the electronic health record, the primary care visits, the telehealth visits and any ER hospitals visits. So, you could see care that way.
So that's good. But I think we're struggling, how do you do the most efficient manpower with providing this hybrid telehealth, inpatient care? And so, I think there's going to be jobs coming out of that as we rethink that whole care model. And what's the best for hybrid care? And at the end of the day, I think patients want to know that you know them, that they have a relationship with you, that there's trust. And that's what I love about primary care. That you know them, you know the family and I think this is a challenge for us. How is medicine going to be practiced in the next even five years? How do we create a system so we get the care we want to have and we want to have for our parents, our families?
Because not that long ago, physicians were practicing in their communities where they'd go to the grocery store, they'd go to the church, they'd be in community organizations. Their kids were in school. And they would know a lot of things about the community. Like the plant was closing down, there's a new employer coming into town, or there's been clacks in the last week and this family was impacted. You knew things about your patients because you were part of that community.
And now we are practicing a lot of times away from the community. We're on telehealth or we're covering different hospitals, or we're doing different things like that. And so, we don't really know the patients in the context outside the visit, like we did in the past. And I think that impacts our decision making or how confident we feel in our decision making.
To me in the future, we're going to have to figure out how to bring that context. And that's really where we start talking about social determinants of health, knowing more about your patients, knowing do they have housing insecurity? What's happening? Is their daughter bringing their food? Do they have food insecurity? Because they're struggling because the plant closed. Like what do you know about them? And when it's just becoming more as a systemized way to approach people that we used to kind of just know because we knew that family.
And when I think about this whole trust in knowing I hate it. When I go and I have to call someplace and you have to verify yourself multiple times. You put all this security information, they say, okay, and they pass you on and they want it again. I hate that. It feels really inefficient. I feel like you should know me. And I think patients feel like that. They feel like why I have to tell my story to so many people. I'm always trying to think, how can we know people, have a good handoff, make it efficient for the patient?
And I do tie this back to what your question was of where's the jobs in the future. Because there's going to be all those jobs, having a strong care team, a strong care model and who are going to be the physicians who are working on building that, whether it's data, technology. Epic has a big influence on us. Epic and Cerner.
John: Exactly.
Dr. Laura Clapper: When all physicians are sitting around talking about Judy pajama rounds and how they have to do extra hours doing their epic and closing their charts, I'm really a big believer that in the next 10 year... Well, I hope everyone's laughing when they're hearing that because it's really influenced physician's lives or families and everything. It's good having the documentation and you can go anywhere in the system and know if someone needs a mammogram.
That's great, but it's come at a cost. And the cost has been unevenly born by physicians at doing all this documentation that hasn't been taken into account. So, my hope is in 10 years, we have a different addition, whether it's a disruptor in the EHR space or they've evolved with Oracle acquiring Cerner. So, it is not with Scribd, but we actually have a better system.
I think that's just one way where I think there'll be jobs and technologies, especially for people who've practiced a long time because they know how it works and they know how people use electronic health records. They know how to use their phrases and can set it up. And people who are really good at being efficient in the EHR, they did EHR since medical school and residency and things like that. There's a huge gap. And so, how do we close that gap so everyone can be good at it? And I think better technology will do that.
I think that we'll start to see more physicians working with startups and independent boards and advisors with startups that's still growing, even with what's going on with the stock market and venture capital. I think this is kind of a pause, but I think that mostly more of that biotech and biosimilars, genetics, all these areas are growth areas, cellular therapies. They tend to be focused on certain specialties in certain areas. And if you're one of those, that's great, but I think there'll be more roles in those areas also.
And one of the things I pursued during the pandemic was actually working on getting my executive coaching certification. And I think we're going to see more physicians as executive coaches too in all different ways. More working on the team, maybe across the hospital. That would be my hope and dream that we really see physicians as an important part of the leadership team in health systems and having them play that role of being executive coach, be actually executive coaches with different executives, as well as other kinds. I think working as an executive coach/advisor at startups or other kinds of ways where you see executive coaching brought in. And so, I think there's a lot of different roles that will come out in the future.
John: Awesome. That's a good overview. When you were talking, I was thinking back to when hospitalists were first introduced and you talk about not knowing the patient. And then telemedicine another example. And so, how somehow the technology has to bring this all together. And then as far as the coaching, I had a physician once. He was a pretty stodgy old man like me. He was like, I don't get it with all these physicians becoming coaches. And it was just funny because business people have used coaches for years. In fact, I have a friend who requires that. He won't take a job unless they're going to give him a business coach.
And so, physicians are left to wander and learn on our own. It's like, that's not good. So, mentors and formal coaches make sense. I'm glad that you're getting involved in that. And especially executive, when you combine physician and executive roles, that's not something that's easy to navigate when you have no background in that. Even if you get an MBA or something, it doesn't teach you how to be a physician executive by any means. So that's fantastic. Well, we're going to run out of time here. Anything else you want to add to what you've already told us? Give us a glimpse and some ideas to shoot for potentially.
Dr. Laura Clapper: I really like what you said about the executive coach and having physicians who are taking on leadership role, even if it's short-term coaching for their first 90 days or for transition in the role. Other roles on the executive team are having coaches. I think as a physician, I wouldn't even have thought to ask for one. And I think we kind of have to increase our awareness and our negotiation into thinking about that. But you and I also talked about other categories. So there's cellular therapies is more combination around the pharmacy and biosimilars, and I think there's going to be a big change, especially with this inflation reduction act of how pharmacy is going to change. And I think there'll be roles for physicians in that as well as with the medical clinical liaison roles. But I think there's also these roles about how pharmacy and PBMs are going to work because they're going to be changing. And the value-based insurance design and how physicians play a role with that.
But I think also women's health is becoming a big area. I just recently was the chief medical officer in FemTec Health and really thinking about how do we address the disparities in health for women. They have a much higher autoimmune burden in terms of incidents of autoimmune disease. And those diseases tend to take six to seven years to get diagnosed.
John: Yeah.
Dr. Laura Clapper: They tend to be more vague. And so, people don't really think about the autoimmune. So how do we create either pattern recognition or profile to help or earlier identification? I think it is really important. Think about endometriosis. It's a very underdiagnosed condition. People may show up in the ER and say they have abdominal pain. They are having fatigue, different things that are seen as vague issues. And then when they're trying to get pregnant, usually endometriosis starts to be diagnosed either by very heavy period or when someone has infertility issues and then they'll figure it out. So, I think we really need to start. And I think part of it is we don't code it. We don't diagnose, we don't code it. So, we don't find people who need the help early enough. And I think it's partly because we didn't think about electronic health records or other kinds of visit forms to even start thinking about asking the right questions. We don't ask the right questions so we don't think about it. The prompts aren't there. And so, it gets lost. The story I like to think about, they had the Apple watch, everyone loves the Apple watch. It took them actually a couple years before they even added the last menstrual period into the mix.
John: Oh, really?
Dr. Laura Clapper: It was more than two years. And even then, they don't have other kinds of questions. We might have a lot of data. We may have technology and devices, but we haven't really thought from the women's perspective first, how to bring these things together. And yet even the work that we're doing in terms of Medicare and Medicare advantage and all the boomers, the growth that we're seeing in Medicare. There's a lot of startups in the Medicare space. And yet who's in the Medicare space for most of the time? It's older women.
John: Yeah.
Dr. Laura Clapper: I think we're going to have to rethink the care and the guidelines for older women. So, there's lots of new kinds of specialties or areas that I think physicians can take their clinical knowledge and really pursue.
John: Yeah. I think we've probably both been exposed to people that are interested in AI and with AI you can recognize patterns. They're not necessarily markers. They're just like patterns of behaviors or background or exposures, which it's just beyond me. I don't even understand how you would capture all that and put it together. But almost to where it'd be like a dog that could sniff a cancer and something totally off the wall, but it'll get there eventually. So, there's lots of opportunities.
I know that our listeners are going to have a need or a desire to get in touch with you somehow. So, I know you have a LinkedIn profile. You're there and I'll put that in my show notes. Any other ideas of how they can find you? Is that the easiest?
Dr. Laura Clapper: I think that's probably the easiest. The other way is through the American Association for Physician Leadership. I think that if you're a member, you can link up with me or connect with me that way. I teach in the Capstone Faculty. That's actually another thing that I think is a good step towards if you're interested in a more physician executive career.
John: Absolutely.
Dr. Laura Clapper: If you are thinking about getting CPE, you can do it. You don't have to go get a masters. You can take the different courses at your own pace. And I think that I've found that people get a lot of benefit from that. I got a lot of benefit personally from it and I continue to see people learning and having that kind of peer group they can talk to.
John: Well, you're in that group like "Oh, I'm one of these kinds of people. I'm one of those that are doing this medical directorship or CMO role or whatever it might be." And anyway, your comment too is very good timing because I believe that the podcast either before or after this one is my interview with Dr. Peter Angood. You didn't know that, did you?
Dr. Laura Clapper: I didn't, but that'll be great. He will be a wonderful interview.
John: Yeah. He's great. All right. I think that we are over time now. So, this has been really fun, Laura, a lot to think about. And I really appreciate you for spending this time today with me and going through some of this. Maybe we'll have you back on some time down the road.
Dr. Laura Clapper: Thank you, John. Thanks for having me. The pleasure was all mine.
John: All right. You take care. Bye-bye.
Dr. Laura Clapper: Bye.
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