Monday, May 22, 2017

HCSI Interview with Dr. Josh Luke

In this show, Lance King of HCSI ( interviewed Dr. Josh Luke, Healthcare Futurist and #1 Best Selling Author of “Re-admission Prevention: Solutions Across the Provider Continuum”(

Josh Luke began his career in sports marketing. He then was a nursing home administrator and then hospital CEO. After ten years, Luke found himself out of a job with no health insurance for his family, plus his mother was diagnosed with Alzheimer’s Disease. Because of his experiences on both sides of healthcare, he has a perspective few administrators do. Dr. Josh Luke now uses that perspective to build population management strategies that create new revenue streams for health systems.

Josh worked for failing hospitals and care centers and made them successful, so he was known as a turnaround king. He also had his share of failures of his career. His largest failure was helping hospitals implement value-based care. Case managers have been the advocates for patient choice, but hospitals need to educate case managers on what the actual choices are. Josh tried to change check-out process to be more efficient. There was such push-back from case managers that it almost didn't happen. He learned that case managers must be more educated by hospital administration, so that they can better educate patients on their options.
Another thing that needs to change in our healthcare system is scripting, where the physician or case manager communicates patient care needs and how to meet those needs. Often, a case manager doesn't communicate the patient's right to go home, the risks that involves, and the home-based options that are available. Patients have never felt empowered to question doctor orders to do inpatient care but they should.

Value-based Care
Josh didn't think anyone thought about what happens if Obamacare goes away until election night. He says to think about when your checking account is empty, you don't spend money.  Now government has no money in account, so something needs to change but there are no good options right now. The traditional hospital model was fee-for-service, where the provider gets a fee for providing service; there was no criteria or accountability. For example: ER doctors did not (and still often do not) evaluate whether a patient actually needs to be admitted; they tried to admit as many patients as possible to receive increased revenue. Now
, the Affordability Care Act forces hospitals to have a value-based approach, which gives incentives to providers for keeping patients healthy so they avoid the hospital. Josh says, “In value-based care, any time a patient goes to the emergency room, that shows a failure of the system 80 percent of the time.” This is similar to thoughts shared by Dr. Paul Roemer, in a previous interview.
The main reasons patients go to the emergency department are because the patient didn't call the hospital or doctor first, or a senior citizen is scared after being discharged from the hospital. Josh Luke says that the inherent challenge in delivery (fee-for-service) model is that people understand that they can go to emergency room to get care without having to pay for it. This concept pre-dated the ACA and until we talk about access to free clinics to eliminate this abuse of system healthcare costs will continue to increase.

Affordability Care Act
Dr. Josh Luke says the ACA is failing because not every American wants insurance, many are not willing to pay for it, and most people under 40 don't need insurance. Then, instead of having the healthy population who don't use insurance help cover the costs/risks associated with older and sicker people, they pay the penalty fee for not having insurance. This makes costs associated with the ACA higher than anticipated because fewer healthy people opt-into health insurance coverage. Josh says that the benefit of the ACA, whether you like it or not, is that it expanded access to healthcare. Americans did not have the expectation of healthcare as a right in the 1980s; now after almost a decade with the entitlement, the percent of Americans who view healthcare as a right has increased. The ACA forced hospitals to think about post-acute care because it is value-based. When the ACA was introduced, readmission prevention had no data or enthusiasm behind it. No one knew anything about it, and the ACA was punitive and difficult to understand. Josh realized he was becoming an expert in value-based healthcare and readmission avoidance because no one else wanted to be the expert. He saw that people really gravitated to his personal story and professional story. He's now a champion of hospitals coordinating care with nursing facilities, and home-based care.

Vision for the Future
Josh says that the model of future is not readmission prevention, it's admission prevention. Where the government or insurance says to the health system, “Here's the allotted amount of money; take care of this patient with this amount.” Health systems are being forced to be accountable, efficient, and use pre-authorizations, and patient education to contain costs. He thinks the long-term impact could be the elimination of middle-man insurer, or at least having the power be transferred from the hospital or health system to the insurer. The basic premise of the ACA is to reduce spending and dollars, but increase and improve care. This means that as revenue dips, staff will be reduced or hospital will be closed. Core staffing requires minimum number of employees to stay open. Hospitals/health systems will need to focus on ways to make money outside the hospital if they are going to be successful. Hospitals used to be the king in a health system; now, they're the biggest expense.  Josh specializes in helping administrators find other revenue streams besides the hospital.

How Can Patients Save Money in Healthcare
Josh says the best way for patients to save money in healthcare is to become educated on available treatment options, including home-based care, and feel empowered to question doctors orders. Josh has realized that the rest of us must adapt to millennial culture of having a computer-in-hand; healthcare needs to adopt technology. (This sentiment is shared by many of our past interviewees, such as Scott Roethle and Bruce Blausen.)  Also, millennials define healthcare as living healthy, which is the future of healthcare. Josh is writing two books, commissioned by Forbes, about this topic. The first one is titled Is Healthcare Bankrupting Your Business and What are You Going to do About it?, and it will be released Fall 2017. It will focus on how executives can save money on healthcare for employees. The second book is called Is Healthcare Bankrupting Your Family and What are You Going to do About it? Its expected release date is Fall 2018, but it may release as early as Spring 2018. This book will focus on ways people can save on healthcare for themselves, their family members, and their aging parents.

Personal Habit Contributed to Success
Josh has developed the power of listening to and understanding his audience. He has an undergraduate degree in communications which is how he learned the value of “understanding your audience before you open your mouth.”
Also, when he trained as a nursing home administrator, he worked in every department for two weeks. While washing dishes with an immigrant who only had a high school education that more employees that could relate to the dishwasher than a CEO in a corner office and he adapted his managerial approach accordingly.

Three Absolute Truths
Josh has learned three absolute truths in his life, and they are:
Having a partner that is committed and lifts you up (and whom you lift) is necessary. He is thankful to have found that in is wife of almost 20 years.
Having alone time is important. Meditation, prayer, and thinking alone helps you know who you are.
It's important to play as hard as you live. He loves to travel with his family and is glad to be able to teach his children that it requires hard work to achieve the things you want in life.

Parting Advice
With regards to healthcare, please feel empowered to ask questions for yourself, your family, and your aging parents. Ask what your options are and question doctors orders, especially if they involve staying in the hospital.

Books and Contact Info
Re-admission Prevention: Solutions Across the Provider Continuum is written for hospital administrators and healthcare practitioners. It is very tactical and the only idea that costs money is the actual price of the book.

Ex-Acute: A former hospital CEO tells all on what’s wrong with American healthcare, What every American needs to know exposes the underbelly of healthcare, talks about why it's so expensive and empowers patients to question providers and know their options. He says it's fun and entertaining, and a quick 3-hour read. It also includes a glossary of terms for those unfamiliar with the industry.

Look for Josh Luke on LinkedIn and twitter (@joshluke4health), or visit his website He would love to speak at your company's event, and he usually brings a free copy of Ex-Acute for attendees.

Josh Luke Bio
Dr. Josh Luke is a Healthcare Futurist and #1 Best Selling Author of Re-admission Prevention: Solutions Across the Provider Continuum. After ten years as a hospital CEO, Luke was out of a job, had no health insurance for his family, and his mother was diagnosed with Alzheimer’s Disease. He now finds solace in sharing his experiences as a caretaker for his mom; and being without health insurance for his family has given him a deeply emotional understanding of the other side of care delivery. Dr. Josh Luke’s expertise is in developing population management strategies that create new revenue streams for health systems. Luke shares Best Practices nationally to ensure hospitals develop revenue-driven programs in the post-acute, healthy lifestyle and wellness sectors. Peers describe Luke as innovative, a thought-leader on population management, coordinated care, and readmission prevention — as well as a “futurist” on the Affordable Care Act and how it will shape the continuum. He authored a book titled, “Re-admission Prevention: Solutions Across the Provider Continuum”, which is the best-selling management series book of the year for the American College of Healthcare Executives. Experience includes Executive Faculty at the University of Southern California, Sol Price School of Public Policy, in the Healthcare Administration Department at Cal State Long Beach and also at Cal State Fullerton. He is also a former Board member for the Hospital Association of Southern California and the California Hospital Association Center for Post-Acute Care. Having uniquely worked in acute & SNF, Luke founded the National Readmission Prevention Collaborative in 2013 and the National Bundled Payment Collaborative in 2015, to showcase Best Practice integration models. He currently serves in an Editorial and Advisory Board capacity for several organizations including the Readmission News. A veteran hospital CEO, Luke also designed the Total Wellness Torrance population management strategy working with the ACO, Bundled Payment & IPA teams while serving as Vice President, Post-Acute Services for Torrance Memorial Health System. TWT and its Post Acute Network received the 2013 Excellence in Programming award from CAHF.

Thanks to all our listeners and viewers! Remember to contact Lance King of Healthcare Compliance Solutions, Inc for all your compliance needs. See more interviews at our website,, on Facebook @hcsi, or on YouTube and PodCast and search for Doctor Entrepreneur.

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Dr. Josh Luke Interview

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