Ep23: Dr. Wael Barsoum, President & Chief Transformation Officer at HOPCo

Hills and Valleys is a podcast that uncovers stories from leaders in healthcare, tech, and everything in between. Straight from the heart of Silicon Valley, we give you a look at the good, the bad, and the future, one episode at a time. Brought to you by Potrero Medical.

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About Dr. Wael Barsoum

Dr. Wael Barsoum is an innovative, value-driven orthopedic surgeon with 20+ years of experience in promoting growth, performance, and leading change.  

As President and Chief Transformation Officer, Dr. Barsoum leads HOPCo’s market transformation initiatives by further aligning stakeholders to continue the shift from volume-based care to value-based care models.  He also oversees HOPCo’s musculoskeletal service line hospital integration, musculoskeletal specialty hospitals, quality programs, and operational teams.Prior to joining HOPCo, Dr. Barsoum served as the CEO and President of Cleveland Clinic Florida.  

During his tenure, Dr. Barsoum cultivated and transformed Cleveland Clinic Florida from a $600M, single, 155-bed hospital system with 9 remote sites to a $1.8B, 5-hospital, 1,083-bed tertiary and quaternary care hospital system with over 40 regional sites.  This transformation was made possible by Dr. Barsoum’s successful and seamless integration of Martin Health and Indian River Health Systems, which resulted in significant growth in volumes, revenue, and profitability, as well as improvement in key performance quality metrics across the Florida region.  

Dr. Barsoum has also published over 200 peer-reviewed articles, presented at over 300 conferences internationally, and is a member of both the prestigious Hip Society and the Knee Society.  He is also a board member of the Florida Hospital Association.

Dr. Barsoum is an effective visionary adept at forecasting future challenges and instituting roadmaps for organizational success, examples of which include the development of the Enterprise Surgical Council, the first Cleveland Clinic Surgical Operations Playbook, and the creation of the Check Please Cost Transparency Program. He also incorporated novel software solutions and predictive analytics into surgery scheduling operations globally for the Cleveland Clinic.

Be sure to follow Dr. Barsoum on LinkedIn and Twitter @WaelBarsoumMD For more information on HOPCo visit https://hopco.com/

?       Interviewer: Omar M. Khateeb, Director of Growth at Potrero Medical

?       Interviewee: Dr. Wael Barsoum

Khateeb: Hey everyone. It’s Omar M. Khateeb, the Director of Growth at Potrero Medical with another fantastic episode of Hills and Valleys. Today, I finally got an interview that I’ve been trying to get with Dr. Barsoum for a long time.

Dr. and I are connected on LinkedIn. He’s somebody whose leadership posts and story has always been very inspiring for me. Many of you have known him as the former president of Cleveland clinic, but he recently just took over the leadership role in helm over at HOPCo, which is a very interesting organization. So, aside from getting his story, I wanted to have him on to talk about his new role and the mission and vision of Hopkins.

Dr. Barsoum, thank you so much for joining us.

Dr. Barsoum: Thank you, Omar. It’s a real pleasure. Thank you for having me.

Khateeb: I think the first question we have to start off with is who is Dr. Barsoum and where did you grow up? Where’d you go to school? Why did you choose medicine?

Dr. Barsoum: Sure. I’m an immigrant. I was born in Jordan to Egyptian parents. My father is an anesthesiologist and we moved here when I was a little kid for my father to do his internship and residency here in the United States. Of all places, he ended up doing his anesthesia residency at the Cleveland clinic. So, we lived in Cleveland.

I grew up most of my life in Cleveland in the shadow of one of the greatest healthcare organizations in the world. Lo and behold, about 20 years after we moved here, I ended up going in and out of the same door as my father did during his training where I did my training as an orthopedic surgeon.

When I was growing up, I got to go to a great all boys prep school. It was a high school called University School in Cleveland. It’s actually interesting because we had only three rules at the school. It wasn’t even rules, but it was kind of what we lived by. They were loyalty, responsibility and consideration. That was it. If you took those three values and lived by them, you would be successful in University School.

It was a great place for me to grow. A lot of my leadership skills came from there. I then went to Case Western Reserve for undergrad which was a fantastic experience for me. It was very educational for me, not only academically, but also in terms of learning how to live with other people and compromise and appreciate differences in folks. While there, I was president of my fraternity house and then became president of the Interfraternity Congress. Those were great leadership opportunities for me.

I then ended up going to Ohio state for medical school and spent my last two years at Ohio state at the Cleveland clinic as a medical student. So, we had a program that only lasted a few years, but I was lucky enough to be there during that time. And it was great because when I did my medical school rotations at the Cleveland clinic, they really weren’t used to having third and fourth year students. So we were almost treated as sub interns the whole time. I got to grow up pretty quick which was a great experience. I ended up matching at the Cleveland clinic and did my orthopedic residency there and then my fellowship at New England Baptist hospital in Boston, which was just an absolutely incredible place to spend my time as a Hip and Knee Replacement Fellow.

Khateeb: That’s amazing. What an honor, I’m sure your father must have been so proud considering Cleveland clinic is such a well-known institution in medical history. The fact that your parents immigrated here and your father got his opportunity at Cleveland clinic. And then his son went back to lead it as a CEO.

What a wonderful story!

Dr. Barsoum: Well, it, it has been a wonderful story. I let Cleveland Clinic down in Florida. My good friend and colleague, Tomi Mihaljevic, who is world famous cardiac surgeon now runs the show across the healthcare system. But it has really been a great experience.

Again, I remember playing hooky from school a few times as a kid and going to the hospital with my dad. I was making rounds with them and even being in the operating room, peering over the curtains and watching surgery. That was really what sealed the deal for me.

Probably about 10 years ago, he came back to the Cleveland clinic for a doctor’s appointment and I had a bunch of surgeries that day. They said, why don’t you come down to the O.R. and watch your son operate? So, he came down and got to see all of his old friends from anesthesia and spend some time with me in the operating room, just observing. It was really a neat day.

Khateeb: What a wonderful thing. It’s funny that we have a very similar background, Like you, I’m a first-generation immigrant and my father is from Iraq. He is actually a general surgeon, but he trained at Cook County. You touched a very special part because back in the good old days before you had vendor check-ins and everything, I used to just go into the hospital when I was 16 years old and just say, Oh hi, I’m Mazin Khateeb’s son. I’m heading over to watch a couple of surgeries and stuff. What a great thing.

I want to definitely jump right into HOPCo, but before I do, after leaving an organization like the Cleveland Clinic what were the big leadership lessons? I ask this because you became somebody there before you left. What were the big leadership lessons and things you took away from it that you’re bringing to HOPCo?

Dr. Barsoum: Yeah, a couple of things I would say. First of all, I learned that great organizations invest in their people. They invest in their talent and the Cleveland Clinic does that well. That makes a big difference and that’s number one.

Number two is that you need to handpick your leadership team and you need to find the best people and empower them. I’m a big fan of being the least intelligent person in the room. For me, that’s not hard to do. But it’s always great to really surround yourself with really intelligent, hardworking, committed people that know their space better than anybody else in the world.

It’s interesting that I still write a lot of papers. I’m a very academically involved person and I tell our residents and fellows all the time that, when you write a paper and get that paper published, you are the world expert in that topic. Nobody else knows more about what you just reported on than you. I think that’s a pretty exciting thing.

Surrounding yourself with people that really understand operations, strategy, and finance is really a key. I’m also a big believer in not having silos. I think if you can tear down some of the silos so you get appropriate cross-pollination amongst the groups and people are there to support each other, that really makes for a strong leadership team that succeeds together or fails together. By the way, failing every once in a while isn’t the end of the world. If you never fail, it means that you haven’t taken enough chances in life.

I’m a big believer that you should lean in and be on the leading edge, especially if you are at a forward-thinking organization. If you were at a leading organization, and you don’t lean in or take risks, then you will fall behind because somebody else will pass you.

Khateeb: That’s a really good way of putting it. I love that analogy because you’re absolutely right. It’s either you could lean in and you fall forward or you lean back and you just fall flat on your butt, if anything. That’s a fantastic way of looking at it.

After spending some time at the Cleveland clinic again, it was a very big news in our industry when you had left to go over to HOPCo. Who is HOPCo? What do they do and what took you over there?

Dr. Barsoum: HOPCo is a really incredible company. Talk about leaning in.

My good friend, David Jacofsky, who is a Mayo Clinic/Hopkins-trained Musculoskeletal Oncologist founded HOPCo about 15 years ago when he founded the core Institute, which is now one of the largest musculoskeletal providers in the Southwest quadrant of the United States. He was section head at the Mayo Clinic in Rochester and decided that we ought to be able to provide higher value care to patients as a country.

Then he put together a whole business plan about taking global risk in a population health model in musculoskeletal care. I remember this vividly because when he was leaving the Mayo Clinic, he called me (I was at the Cleveland clinic) and said, why don’t you come with me? And I thought the guy was talking a different language. Honestly, I didn’t understand what he was talking about when he said, we’re going to set up shop in Phoenix. We’re going to build a practice and that practice is going to manage musculoskeletal service lines. He said we will eventually build a network that will take full global risk in musculoskeletal care.

I just didn’t get it to be honest with you. I think most people at that time would not have understood it. The only example that we had around global risk was Kaiser, a really incredible organization that has done incredible things. But that wasn’t really a model that was taking off around the country at the time. Very few people were talking about things like population management. So, I waited a few years and continued to grow my career at the Cleveland Clinic. I was academically active and did a lot of great things.

I watched Dave as he grew a practice into truly a national and international leader in healthcare delivery. I watched him create an infrastructure around that practice that ended up managing musculoskeletal service lines, managing orthopedic practices around the country, and then eventually creating clinically integrated networks of providers that would take full capitated risk in musculoskeletal care. That’s a really incredibly forward thinking idea today, let alone 15 years ago, for somebody to have been thinking in that space.

It took a little while to build all of the pieces, but today HOPCo is 1500 employees strong with another thousand folks that are co-managed with our industry partners. We work in 80 different healthcare systems around the United States today by managing service lines, convening bundles, and managing musculoskeletal practices. We own our own specialty hospitals. We own ASC and partner with other organizations. It’s really one of the most flexible organizations I’ve ever seen when it comes to being a vehicle for the alignment of stakeholders. This means that we align payers with healthcare systems, with the outpatient ecosystem with providers, and ultimately with patients. The goal in all of this is to provide higher quality care for lower costs. There’s literally nobody that loses in the model, which I think is really great.

There are terrific organizations out there that are great at the traditional delivery of medicine. Places like the Mayo Clinic, the Cleveland Clinic, Johns Hopkins, UCSD, and lots of really terrific organizations. However, they are great at the traditional delivery of medicine. To lean in now and be great at the value-based delivery of medicine is a change. I think more and more organizations like Intermountain Health and Geisinger are starting to think that way.

They are thinking more about how do we deliver even more value to the communities we serve by not only being the leaders in high-quality care, but also being the leaders in high quality, low-cost care. And that, I think, is a major differentiating opportunity today.

Khateeb: Absolutely. It’s such an interesting thing because originally, I’m from Texas. However, being here in Silicon Valley, I’m part of the Kaiser network, that’s my provider. I like it so much. We were thinking about changing plans but I told my HR representative, I’ll pay more myself if that means I get to stay within Kaiser’s care because they use such a good job of it. To hear that your organization is trying to do this across the nation is fantastic because I think the old model of fee for services needs to go away.

I think that a lot of hospitals are starting to realize that if you really want to be a provider of quality service and care to the community, it can’t be when you show up as a ‘customer’ for services at the hospital. It has to be a full continuum of care and not a lot of hospitals are set up to do that. Quite frankly, I think this is where industry provides a lot of value. They need organizations like HOPCo to provide that guidance in that kind of an ecosystem because from an organizational standpoint, it’s really hard to make these changes alone. You need someone to usher in that way of doing things. Plus, I think when HOPCo is doing this across the nation, it’s like setting up different approaches and experiments and.the whole ecosystem of healthcare starts to benefit because it’s not just one system in one place.

Dr. Barsoum: You’re exactly right. When you’re great at what you do, it’s hard to disrupt yourself. That’s the reality, right? There are great examples of organizations that have been great at what they do but fell behind because they didn’t disrupt themselves.

So, when you think about it, Kodak was an incredible leader in photography, right? However, they didn’t really think that digital photography was going to take off and they fell behind. When I got my first cell phone, it was made by Nokia. Nokia had 80% of the cell phone market. They didn’t think anybody really wanted a smartphone and would spend that money on a smartphone. Today, I’m not even sure that they still sell phones.

That’s the reality. You have to disrupt yourself. Organizations that have done so much of that disruption are companies like Apple. When I was a kid, you could buy Apple stock for $8 a share.

[Khateeb laughs]

Look at it today, it’s unbelievable! Who would have ever thought that a company like Google would become a trillion-dollar company? It’s a search engine, but it’s a lot more than a search engine, right? Because Google kept disrupting itself all along the way. Now they have a whole company around self-driving cars. They have monetized data and gotten into marketing. They do all kinds of things that are different than just being a search engine. I think the huge differentiator is if your organization is able to understand that even if you are the best at what you do, you have to disrupt yourself otherwise you fall behind.

And it happens, right? We saw it happen in the auto industry during the great recession that we just had 10 years ago where GM almost went out of business. GM was still making big cars that guzzled a lot of gas, were expensive and would break down intentionally as soon as the warranty ended. People just started buying more Toyotas and Hondas. Then GM came out of that, recognizing that they had to change the way that they build cars. Today, GM cars are amongst the finest built in the world. They last longer, get better gas mileage, have hybrids, and have electoral electrical vehicles. They’re disrupting themselves and their market and that’s a big key.

Khateeb: Absolutely. I think something we see so often in healthcare is that you get very attached to your babies and you’re not willing to give it up. It’s funny that you mentioned Kodak because I think they should’ve been the ones to launch something like Instagram, but they didn’t want to give up the hardware of cameras. For so many things, companies are afraid to cannibalize their products. Netflix is a great example of that did do that. They started out with the DVDs and then they said, Hey, we should cannibalize this and started doing streaming services. Then they said, we’re going to cannibalize that and we start making our own shows.

I think healthcare really needs to learn that. I feel that as terrible of a thing that COVID was, it accelerated trends that were already happening, but they were not going to get there by themselves. Now we have things like telemedicine come out and we really got a taste of what the free market looks like. A lot of organizations are starting to look at themselves in a tough way and say, we need to change the way things are done because if that day comes, which I hope it does, where if you’re a resident in Texas or in the far East and you say, You know what, I’ve heard a lot about Kaiser and I want to sign up for their healthcare plan. Then that changes the way healthcare looks really quickly, right?

Dr. Barsoum: Well, that’s exactly right. You’re hitting the nail on the head. One of the services that we’re launching soon at HOPCo is a virtual second opinion service.

Khateeb: Really?

Dr. Barsoum: Yeah. So, if you’re a provider in the HOPCo network and you have a tough case that comes in, we want to make sure that you have access to the very best of the best around the country to be able to give you a virtual second opinion and say, Look for that patient, I think you should do A, B, and C. Ultimately, it’s in the best interest of the patient so why would we not provide a service like that?

Khateeb: That’s amazing! HOPCo is leveraging social network effects. More importantly, we keep talking about empowering the patient but the reality is that not every patient is going to be like you and me where we have the transportation, access and the money where if we wanted to get a second opinion, we could. What if you’re a patient who’s in a rural area or a patient who’s a mother with a bunch of kids and you’re working? You don’t have time to get a second opinion, right.

Dr. Barsoum: That’s right. And, Omar, what if you’re a doctor that’s working in that rural area and a patient comes into your clinic with a problem that you need to be able to phone a friend and say, Hey, this is something that’s a little different than what I’m accustomed to, what do you think? What would you do if you were in my position? Again, from a patient’s perspective, you’re not telling that patient to get in their car and drive 80 miles to go see this person. With this technology, maybe they can exchange enough information that that patient can still be treated locally and get the same great outcome because somebody with more experience in that specific area has helped you.

Listen, as doctors, we all need help sometimes. We all need somebody to just tell us, Hey, if I were in your shoes, this maybe is what I would do. Or, have you looked at it from this perspective? So, getting that help is a real benefit.

Khateeb: Absolutely! I love that you guys are essentially providing this both on the physician side and the patient side. One funny thing I heard a while back is that a lot of healthcare is like this triangle where you have payers, providers and physicians blaming each other and arguing about different things. Then you have patients on the outside sitting around and not being involved. However, it sounds like what HOPCo is doing is digitizing and unifying this entire healthcare ecosystem so that not only patients are empowered with more information, but physicians have the channels and the networks to actually do that.

Again, to your point, you could be a physician who’s really open to getting advice and second and opinions, but what if you don’t have the friend or you don’t know who to ask? Then it kind of ends right there.

Dr. Barsoum: Yeah, you’re absolutely right. I think your comment about the providers, the hospital and the payer sometimes not necessarily being aligned is interesting. I think it’s a fair comment, but the reality of it is when you talk to hospital leaders, leaders on the payer side and the providers, everybody wants to do the right thing. I’ve been extraordinarily fortunate to meet with leaders on the insurance side over these last several years and I’ve always been impressed at how committed they are to really trying to design benefits that best meet the needs of the patients that buy their plans and to be able to pass along the savings as they’re negotiating rates.

They’re very value-driven and for good reason. I meet with hospital leaders all the time that want to do the right thing for their patients. I’ve had the opportunity to work recently with some leaders at Ascension healthcare here in Florida. I’ll tell you what, talk about a mission-driven organization and they’re right on top of the list. Every time I’m up there, I’m blown away by their commitment to care for the poor. They are committed to doing the right thing for patients every single day, regardless of the cost. They want to do the right thing!

Doctors want to make sure that their patients have access to the very best care at the lowest cost. No doctor wants to have a patient that didn’t do well, right? We all want our patients to survive and thrive and be happy about the fact that they chose us to be their provider. Although it sounds terrible, the truth of the matter is that a lot of this semi-distrust amongst the different factions involved has just been messaging that’s been lost in translation.

All of these organizations and groups want to do the right thing for patients. It’s just a matter of being able to align them on a platform that does that alignment. And that, I think, is really the extraordinarily unique thing that HOPCo does.

Khateeb: What’s most interesting about it is that it’s not anything that the market is not used to.

We’ve seen this done on LinkedIn in terms of bringing together professionals, Twitter in terms of bringing people together for other things. If you look outside of business at The Beatles, for example, they didn’t invent teenage girls, but they brought them all together.

I think real movements, both in popular cultural medicine and business is platforms that are established to bring the right people together to make better decisions?more informed ones. And it sounds like that’s what HOPCo is doing.

Dr. Barsoum: That’s exactly right. It really is exciting to watch as we’ve been growing. Today, the number of opportunities that we have throughout the country and even internationally, if you can imagine, have just been growing logarithmically. It’s incredible. The amount of growth that we’re seeing and the number of opportunities that we’re getting to go and speak with some of the most impressive healthcare systems in the country is mind boggling. To me, I think it’s a real credit to my good friend who started the company and had the vision to do this and has stuck through it, and the team that he’s built. It’s an organization that’s led by physicians, but also very well professionally managed with non-physician leaders as well.

From the finance group, to the business development group, to the medical economics group, to the legal sector, all of these folks are just really top notch. But a group of orthopedic surgeons and physician assistants that are in there every day leading the effort is an impressive combination of folks.

Khateeb: Now I do have a question and it could be not relevant to HOPCo. You guys are really focused on musculoskeletal services. Does that also include things like in-patient rehabilitation?

Dr. Barsoum: Just to put things into perspective, we take full capitated risk on about 26,000 ICD-10 codes, which represents about 30% of the ICD-10 codes that CMS recognizes. That includes everything musculoskeletal, including spine, rehab, neurosciences and pain management for that matter.

They all fall into that bucket that we take risk on. Again, I think what’s very unique is this idea of sub-capitating out musculoskeletal care. You might say, why that. First of all, obviously we’re orthopedic surgeons, so it’s what we know. However, the other part of it is musculoskeletal care is one of the most quickly rising costs in healthcare. If you look at cardiac care, for example, Omar, the cost of cardiac care has gone down. Drugs like Lipitor and Crestor have all made us healthier. So, we’re getting fewer open-heart surgeries. We’re having fewer interventions.

With musculoskeletal care on the other hand, the price is going up anywhere between 8-15% a year, depending on where you are in the country. That’s a massive opportunity for real disruption to bring down that cost of inflation and actually cause deflation. That’s exactly what we’ve done. In one of the first clinically integrated networks that we built in Phoenix, that group took risk on around a hundred thousand lives and today saves about $32 million a year in its run rate compared to when they started. So, every year they’re taking more and more costs out of the musculoskeletal spend. And what’s very interesting, Omar, is that as a physician your bonuses in that clinically integrated network are based on you following the peer-reviewed, data-driven clinical care pathways that have been shown to lead to the best outcomes.

So, if a patient comes to your office and clearly needs a knee replacement and you say, “Well, it’s population health, I can save money by not doing the knee replacement,” you’ll actually get dinked. So, it’s not about withholding care. It’s about providing the right care at the right time in the right setting and that’s really the key. Many people will think that if it’s population health and you’re saving money, are you withholding care? That’s absolutely not what we do. In fact, it’s quite the opposite. We ensure that the right patient gets the right care immediately. That ends up saving a lot of costs because instead of a patient that clearly just needs a knee replacement, we don’t send them for an MRI or a bunch of injections that we know aren’t going to do the job.

We instead just recommend getting the knee replacement.

On the other hand, the patient that shows up with two weeks of lower back pain doesn’t just get a discectomy. They get physical therapy and get worked up appropriately. Now, if they have acute foot drop or they’re having some cauda equina symptoms, that’s different. They’re going to get treated through a different pathway. So, it’s all around ensuring that the right patient is getting the right care initially which, by the way, from a patient’s perspective is really nice because you’re not going down a bunch of rabbit holes to finally get better.

Khateeb: I think that’s where we start seeing this huge increase in the cost of healthcare. To your point, the thing about musculoskeletal disorders in healthcare is that there are so many different approaches. If you need to a cardiac bypass, you might be able to go to interventional cardiology and get some stents, but at some point, you’re going to need the bypass.

But with musculoskeletal care, there’s so many different pathways where you can end up spending a lot of money just to end up at the point of, let’s say, needing surgery.

But that patient already ended up having to spend a whole lot of money just to get to that point. It sounds like you guys are using an algorithmic approach to say, here are the pathways and here’s how we get the best care to the patient at the lowest cost without having to go down these other routes. For instance, if a patient wants to get injections for pain, any physician?even coming fresh out of training?can evaluate them without an MRI and just say, you can do this only for so long, and you’re still going to need surgery, you might as well consider doing the surgery now before it gets worse.

Dr. Barsoum: Yeah, that’s right.

Khateeb: I do have an interesting question. It’s a technology question that caught my eye coincidentally during the last month or two.

One of my mentors and the first CEO I worked for?Christopher Prentice from Mazor Robotics?joined a new company called Harmonic Bionics. It’s a robotic company for rehabilitation of the upper extremities. One of my close friends and the first person I met here in the Bay is Nathan Harding, who’s the founder of Ekso Bionics. They’re the first real big bionics company in the rehabilitation space. I think they just got clearance for a stroke and a few other indications over the summer. When I started seeing this, especially with my mentor going into this new company, I said, what’s going on in the rehabilitation space? When I looked into it, I realized that it’s very outdated because it’s mainly done with just human beings and there’s no technology involved. It seems like there’s more technology being introduced in the rehabilitation space. Plus, I think the Medipack study showed this increase in rehabilitation centers and the amount of people going in for rehabilitation from stroke and other things.

Where does HOPCo fit in when it comes to evaluating how we make rehabilitation better and more efficient? And then, how do we utilize new technologies, whether it’s Ekso Bionics or Harmonic Bionics, into these centers to improve the care?

Dr. Barsoum: That’s a great question. One of the big areas of focus right now for us at HOPCo is the use of sensors for patient-driven physical therapy. This means you’ll have a sensor on that will actually look at you kinematically with the use of your camera and tell how high, for example, you’re raising your arm if you’re doing rotator cuff strengthening. It can also tell how far you’re externally rotating or how far are you internally rotating. So, it almost coaches you through the use of a sensor.

Now, that certainly doesn’t mean we don’t need physical therapists. There are times where we clearly need a physical therapist, but at the same time you want that physical therapist to be working at top of licensure. So, maybe on the very first visit they work with a physical therapist.

The second visit maybe is through a telehealth appointment. And then, and after that, the patient’s working on their own utilizing the sensors and the sensors are feeding back data to a physician dashboard telling them, “This is what your patient did today. This is how well they did their exercises. And, by the way, the patient’s actually not doing this one right. We need somebody to intervene.”

So, it’s a great way to take a very limited group of physical therapists and make them more effective and efficient by allowing them to take care of more patients through a digitally enhanced platform. We have a spinoff company at HOPCo that’s doing that. There are other companies that are in the space as well. PT Genie is a good example of that and is led by Reuben Gobezie, a world famous shoulder surgeon. Health Excel is a company that is a spinoff from an organization up in Philadelphia where they’re putting together a chat bot that will answer questions for patients if they’re having problems after a knee replacement and they’re not quite sure what to expect.

Questions like, “my knee hurts today, what should I do?” The bots will ask if they took their pain medication that day and how many they have taken to ensure that they’re not taking too many. It might also suggest to them that they’re allowed to take more by saying something like, “Why don’t you take another one?”. Without a doubt, we are really trying to integrate more and more in terms of artificial intelligence, digitally-enhanced care delivery, and remote patient monitoring to try to make our caregivers as efficient and as effective as possible.

Khateeb: When it comes to managing different service lines, does HOPCo also get involved with the customers that it supports in terms of evaluating new technologies? For example, the wave of robotics coming into rehabilitation and how does it integrate to help physical therapists with streamlining things essentially.

Dr. Barsoum: Absolutely. One of the things that I think is different for us is we’re not a consulting company. When we come into a community and we partner with a hospital, a practice, and a payer, we are joint venture owners in what we create.

Khateeb: And you take the same risks together?

Dr. Barsoum: We take on the risk, that’s exactly right. We don’t come in and say, here’s a playbook, best of luck and thanks for paying our consulting fee. To be clear, there are great consultants out there. I don’t mean to sound patronizing, that’s not my goal at all. However, we put our money where our mouth is and we work side by side with that organization. If there’s an opportunity to look at a new robotic enhancement or a new technology, we will be right in the trenches with you evaluating it and deciding with you to make sense for your organization and the community that we’re serving to get that high value care.

Khateeb: Hmm. I’ll leave a link in the notes for people to go check out. I know that there’s a variety of different organizations you already work with, but what’s the ideal organization that HOPCo goes looking to partner up with because obviously as a business, you’re always looking to expand and take on new customers. What’s the ideal customer that you’re looking for?

Dr. Barsoum: Sure. That’s a great question. Omar, we’re not a turnaround company. I mean, certainly we could be, but that’s not our goal. The organizations that we partner with across the board are the best organizations in their communities and that’s intentional. We want to align with the best practices, we want to align with the best hospitals, and we want to align with the best docs. That’s really the key for us.

Can we take a C rated hospital and make them a B+ rated hospital or an A- hospital? Yeah, I’m sure we could, but we’d rather take an A hospital and make it an A+++.

Khateeb: Right, because that’s where the risk is.

Dr. Barsoum: Yeah, that’s exactly right. And the truth of the matter is you’ve got to be great at the basics anyway, but to be disruptive and to be a real leader, you have to be outstanding at what you do. We work hard to align with the very best partners in the communities that we enter. Then with those partners together, we grow them reputationally. We grow their market share on average. We moved 31% market share to the hospitals that we aligned with. We doubled their contribution margin within two years and that’s all because we bring down costs, we improve quality, we bring down length of stay and readmission rates. All of these things together enhance the local reputation of that organization and more volume gets driven to those sites very intentionally.

Khateeb: Got it. We’re doing good on time, but we’ll be coming to a close soon. I have a couple of other questions before we get into our rapid-fire questions. Something I want to touch on is that we do have quite a few hospital administrators and healthcare CEOs that listen to our podcast. When you mentioned earlier about that HOPCo takes on risk, you act as a partner, right? As best you can put that concisely, what does that look like when you say you take on the risk with your parties? What does that mean?

Dr. Barsoum: Sure. So, what we’ll do is we’ll find a hospital group or a hospital partner in a community. We’ll also find an orthopedic practice partner in a community. We don’t have to own the practice, we only partner with the practice. Together we’ll then create a joint venture, which is going to manage the risk and manage the clinical service line at that site in that hospital system. We will then go to a payer and tell the payer that we have an infrastructure that will take risk on whatever number of lives you have?usually it’s Medicare advantage to begin with?but we’ll take risks on commercial lives as well. And we’ll take it on all 26,000 or 27,000 of these ICD-10 codes. We’ll take the full global risk on all of those codes. We’ll then get claims data from the payer to appropriately price what the per member per month fee is and then we’ll take that risk together with our partners.

Now, the beauty of this is we don’t need to create a narrow network. We don’t need to necessarily drive the care just to these sites. We actually layer on our methodology, which includes software and clinical know-how. On our software program alone, we’ve invested $70 million in over the last five years to give us dashboard data on physicians, practices, claims and hospital metrics. That’s what we just layer right on. As opposed to creating a narrow network, we’ll actually be taking risk on lives for patients that are going to providers that don’t even necessarily know that we’re sub-capitating their risk. This makes it very easy for the payer.

Our goal then is to actually take our model and apply it to as many providers as we can in that market so that the entire market sees the benefit of improved quality and lower costs. So, that’s how we do it. It works very nicely. It sounds pretty simple, but candidly it’s relatively complex and it requires a big medical economics infrastructure, which we have. Although we’re not an insurance company, a big part of our 1500 employees is essentially an insurance type infrastructure for looking at claims, understanding claims, cleaning up claims data and monitoring claims to ensure that we’re doing the right thing.

Khateeb: Got it. That’s very interesting. It’s nice to see things like this come out in medicine because it just shows an attempt to really break away from the old system that we’ve had. I think, again, COVID really showed us that we’re all living in a world with systems that are designed by people who are all dead for the most part.

[Dr. Barsoum laughs]

Khateeb: It’s evident when you look at the way our healthcare and our roads. I think this is the time where we have to really look at cannibalizing old industries and approaches and making them better, you know?

Dr. Barsoum: Yeah.

Khateeb: So, we have 10 minutes left. I want to jump into the rapid-fire questions. These are questions that you can take as long as you’d like to answer, but the faster you answer them, the quicker I’ll get to the next one. You can take as long or as short as you want it.

Dr. Barsoum: Okay.

Khateeb: My first question to you is, what is the most memorable thing a mentor ever told you and how did that change you?

Dr. Barsoum: That’s a good question. I had a mentor in high school who told me to slow down and enjoy the ride. He said, I was always driven to try to get into the best college so that I could get into medical school and become an orthopedic surgeon. He said, listen, you’ve got plenty on your plate. Just slow down. You’re going to get there, enjoy every step of the way.

And, in truth, I took that advice. I mean, I really enjoyed college. I really enjoyed medical school. I enjoyed residency. It’s easy being a motivated, hardworking person to lose sight of the fact that some of those are the best years of your life. We all have a lot to be grateful for, so just take a moment, be grateful for all the great things that you have in life. It doesn’t mean you shouldn’t work hard. We have a little saying at home: “wake up, say a prayer, go hustle”. That’s how my wife and I raised our three daughters. It’s, wake up, be grateful for what you have, thank God every day. We’re a very close Christian family and we firmly believe that that’s really the key to success for us. So, we tell the girls every day, right after you wake up, say your prayer and right before you go to sleep, say your prayer. However, you need to understand that you’re still expected to work hard. Things don’t come easy, you have to work hard for them, but enjoy it and be grateful for it.

Khateeb: I love that. My wife and I are looking to have probably our first next year, but I really loved that saying. And at the end of the day, whether you’re Christian, Muslim or anything, as the old saying goes, “God helps those who are willing to help themselves.”

Dr. Barsoum: I think that’s a hundred percent correct. I heard a funny joke a while ago and you’ll probably get a kick out of it if we’ve got a second for it. I live here in Southeast Florida, so we’re always dealing with hurricanes. I don’t mean this to be glib, but there’s a hurricane coming and a guy standing at his house and they say you need to evacuate. He says, no, I have faith. I don’t need to evacuate. I’ll be fine.

The hurricane comes in and starts raining. He gets up on his roof and a guy comes up in a boat and says, Hey, get in the boat. We’re going to save you. He goes, no, no, I have faith. I’ll be fine. I know God’s going to save me.

The hurricane just keeps pounding harder and harder and harder. He’s now standing on the roof with his tippy toes and his face is barely out. A helicopter comes down and drops some a rope and the pilot says, grab the rope and I’ll pull you out. He says, no, no, I have faith. Finally, the guy ends up drowning and he goes up to the Pearly Gates where he meets St. Peter and he tells St. Peter, what the heck, I thought for sure that you guys were going to save me? St. Peter said, man, we sent you a boat and a helicopter and you didn’t want me either.

[Khateeb laughs]

Dr. Barsoum: So, you’re right. God helps those that helps themselves.

Khateeb: Absolutely. Again, even in that joke there’s a little wisdom in there, which is you have to pay attention to what’s going on around you and the context.

Dr. Barsoum: Absolutely.

Khateeb: I think I love that because I’m a very ambitious guy and I like to really be focused on my goals for my organization and everything. However, at at the same time, you have to be grateful for what you have and then really pay attention. Sometimes I think we don’t pay attention to things because if we do, we’ll realize the truth of the situation, and we’re afraid of that.

Dr. Barsoum: Yeah, that’s exactly right. I’ll, I’ll add one other thing too that, that I think you just touched on. I know this isn’t part of your rapid-fire, but I’ll just make this comment. When you talked about Christian, Muslim or Jewish especially at times like this when we’re dealing with COVID, the truth of the matter is we’re all the same. I mean, we’re all people, right? We should all be helping each other and standing by each other.

I don’t think our country has ever been more divided, which breaks my heart. This is a time where we should all be standing together, helping each other, supporting each other and showing grace to one another. It’s really a very difficult time where hundreds of thousands of people around the world die. This really is the time for us to stand together and say, we’re going to put this behind us and we’re going to win. We’re going to come out stronger than we used to be. There’s certainly no harm in showing kindness and I think that’s a big key.

Khateeb: Absolutely. There’s so many things I want to ask you and we’re going to have to have you back. It’s going to happen.

Dr. Barsoum: [Laughs] Okay, sounds good.

Khateeb: My next question to you is what book do you most often gift or recommend to others and why?

Dr. Barsoum: That’s easy. Outliers by Malcolm Gladwell. It lines up with your last question as well. I love that book because it tells you that things don’t just happen randomly. People that are great at something are great because they’ve put in the time and the effort. Now, to some degree there is, some fate involved, right? Well, if you’re a hockey player, where you’re born in the right month to be the biggest kid at the end of the year, that clearly played a role. If you were the Beatles, did you happen to grow up in Liverpool where they had a great music scene, but you still have to put in your 10,000 hours, you still have to play all the lousy, grungy, nasty clubs before you got to make?as you said before?teenage girls swoon.

Ultimately, that’s really what it takes. I believe that everyone should have a goal of being great at something and to do that, you have to identify what it is that you have a not natural, God-given talent for, and then you need to put in your 10,000 hours and you need to make it work.

Khateeb: Absolutely. I’ll just add this quote because I like it. Do you know Matthew McConaughey, the actor?

Dr. Barsoum: Of course. I feel like we look alike, he and I.

Khateeb: Absolutely.

[Both laugh]

Khateeb: A quick heads up for those listeners who have children, please put your children away for a second, because I’m quoting Matthew McConaughey. When Matthew McConaughey was in school, he was actually going to be a lawyer. His father was really adamant about him being a lawyer and he decided that he wasn’t going to go to law school. either.

There was a time where he was either in law school and dropped out or was about to start, he went to his father and he was really nervous. He said, hey dad, I don’t think this law thing is going to work out for me. And his father said, okay, what do you want to do? And he looked down and he was very nervous. He’s like, I think I want to be an actor. And his father said, are you sure that’s what you want to do son? Matthew McConaughey says, yeah, that’s what I want to do. And his father goes, all right, just don’t half ass it.

[Dr. Barsoum laughs]

Khateeb: I really liked that. I told my wife that when we have our kids, I don’t know if they’re going to want to be a doctor, a business person, or an artist. Whatever it is, they have to just be very committed. Just like you said, you have to hustle and take it seriously.

Dr. Barsoum: Yeah. It’s not a random event. The people that you see in the movies making $20 million a movie, they didn’t get there randomly. They’re great singers, dancers, musicians, and they happen to be great actors. They’ve put it all together for a package that makes them stand out.

Khateeb: Yeah, absolutely. We always see when they come out of the other end, when they’re at the Grammys and Oscar We don’t see the many years of loss, failure and living out of a car. All these things, the bad parts, we never see that. We only see at the very end, and we’re like, oh man, this happened overnight.

Dr. Barsoum: Well, let me tell you. If you’ve never seen this, jump on YouTube and just search for Justin Bieber playing the drums as a child. The kid’s like four years old and he sounds like Neil Peart from Rush. I mean, he is a ridiculous drummer at the age of like four or five years old. It’s unbelievable, but that’s what I’m saying. It’s not a random event that he’s a musical superstar now. He’s talented, he put in the time, he was committed and look at where he is today.

Khateeb: Amazing. I’m going to look that up during my lunch. All right, you have one minute left. I have to be respectful of your schedule. My last question to you is this.

I want you to imagine that throughout the United States in every hospital and medical practice, there’s going to be a billboard. And everyone that goes in and out of work is going to see this billboard for a whole year. What message do you put on that billboard?

Dr. Barsoum: Is the billboard for the caregivers or is it for the patient?

Khateeb: Caregivers.

Dr. Barsoum: “Thank you.” This last year, people have put their lives at risk. I’ve seen nurses, respiratory effects techs, ER docs, anesthesiologists, gastroenterologists, and pulmonologists put their lives at risk. It has been absolutely incredible. We had orthopedic surgeons training on how to run ventilators if we ever saw huge surges. Our healthcare professionals, every single one of them.

And, by the way, everyone that works in a healthcare environment, right? The people that make the food, the people that clean the rooms, every one of them put their lives at risk at a time when we had no idea what that risk represented. As a race, we should be grateful for what they’ve done.

Khateeb: Absolutely. I couldn’t think of any better way to wrap up the podcast. Thank you so much for spending some time with us. You’re going to be back on the show, I’m just giving you a heads up from now.

Dr. Barsoum: No problem. I look forward to it.

Khateeb: Wonderful. For the audience, I’m going to leave some links below, including Dr. Barsoum’s LinkedIn profile. Are you on Twitter as well?

Dr. Barsoum: I am.

Khateeb: We’ll get you some followers on Twitter as well. Thank you all for listening. This has been another episode of Hills and Valleys, and we’ll see you next time. Bye for now.