Week in DC: The Urgency of Translation – Advocacy and Scale

Jennifer FluderJeffrey Crowley, Distinguished Scholar and Program Director of the National HIV/AIDS Initiative at the O’Neill Institute for National and Global Health Law, spoke with our class about the need for advocacy and other impact-focused organizations to distill their initiatives as an organization into one base message and action point. Understanding the implications and best practices that can bridge the gap from a far-removed epidemic to a comprehensible and actionable initiative for a legislator is perhaps the most important element of all. Refining the message and ask, Crowley says, will allow for greater probability of uptake by potential partners, including legislators. Within the scope of the translation, being able to bring a situation that may be a world away into relatable terms is a great undertaking, and one that must be done in measured terms. Crowley also discussed the balance of reaching the most senior member of a team versus finding an advocate, who is well enough progressed within the firm to solicit change. An ally who believes in your organization is more important than the title they hold.

Our conversation with Mr. Crowley reminded me of a few studies I’ve read over the years that highlighted the difference in fundraising efficacy when an organization would either share a general statistic, say that 33 million people are living with HIV/AIDS, as opposed to sharing a story about an individual patient. The latter approach proved more successful than the former. If you give someone too much information, or if they feel their impact would be inconsequential given the scope of the problem – that there are 33 million people in need of your help – people are likely to remain inactive.  Here too, as Crowley points out, the need to distill the message of an epidemic into terms where a potential partner organization has a defined role with particular impact goals attached to it is important. The question remains, beyond sharing a personal story, what other tools do we have to translate the need when you can’t bring each potential partner or donor to the peri-urban slums of Nairobi?

Our next speaker, Wendy Taylor, Director at the Center for Accelerating Innovation and Impact (CAII) at USAID, provided us with a vantage point that begins to answer that question. Taylor spent time speaking broadly about CAII and its role as an organization that helps to identify, develop and introduce health innovations into the developing world. Taylor gave our class a deeper understanding of the innovation landscape that the CAII is currently developing including both its initiatives as well as its frameworks to standardize and organize the data they are gathering. This will eventually aid in the translation of the scale of problems as well as the impact of potential solutions.

Both Crowley and Taylor stressed the importance of understanding how a given innovation or initiative fits into the greater context of a community, country or the world. Learning how to make partnerships beneficial for all stakeholders and how to utilize past failures and successes to move forward more efficiently and effectively in the future is a key determinant of success.

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HSM Beyond the Classroom: Duke University Hospital Experiential Learning Project

Claudia BarnaThe Duke University Hospital (DUH) Practicum was one of the most invaluable experiences I have had at Fuqua. Firstly, getting to solve a real business problem in a real healthcare setting proved to be challenging but very exciting. The team I worked with at the hospital looked to me for business insights and advice – which was both awesome and humbling at the same time. Additionally, it felt great to be using my business knowledge in a space where there is a great need for these skills.

Secondly, as someone interested in healthcare but with no previous provider or clinical background, the DUH practicum offered me the hands-on learning you can only get from being in the hospital and working in that setting. Shadowing administrators and nurses/doctors alike was one of the most eye-opening experiences I have ever had, from both a professional and a personal perspective.

Last but not least, getting to present my project to the president of one of the top hospitals in the country is not something many twenty-something year old professionals can brag about. Overall, in just five months, this experience allowed me to grow and learn more than I ever thought I would. I very much enjoyed my DUH practicum and would highly recommend it to anyone interested in healthcare.

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Internship Recruiting: The Value of HSM

Theo AhadomeRecruiting is no joke! You can go from periods of anxiety, to depression, to desperation, to elation – sometimes all in the same week. Depending on whether you caught me on crest or trough of this emotional journey, you would have got some very different responses from me on the value of HSM in recruiting. Now that it is over for me for the summer, I can take a step back and give some honest reflections on that topic. Here goes:


HSM at Fuqua has fantastic alumni in the healthcare industry. As one of (if not the) biggest healthcare MBA program around, this is perhaps to be expected. However, it really dawns on you throughout the process: just about every healthcare company I looked at had a strong and/or growing Fuqua network. This certainly helped in getting to really know the firm and making a decision on if it was the right place for me. HSM seminars and healthcare club sessions also helped give great perspective on different sub-segments and functions to help me figure out what I was most interested in. In that regard, it was a fantastic experience.

Did I get frustrated at times because I had to be in class on Wednesdays and do some extra work that perhaps took away from recruiting time? Yes. Absolutely. However, if I do a cost/benefit now, the fact remains that the benefits above so far outweigh the time cost – and then there is the fact that it helps whip your multi-tasking and organizational skills into shape.

Interview Process

Interviews come down to you. HSM helped as stated above – and maybe even by merely being in the program I earned some healthcare credibility that factored in my getting the interview (but then again just about every other student invited to interview for healthcare companies is in HSM). But now it was all on my experiences and skills. I did have to do some healthcare cases, and here specific knowledge on the US healthcare system from HSM bootcamp was invaluable. The process started from early-January for me – as I also did some consulting recruiting – while the healthcare companies were on campus from mid-end of January.

What was perhaps more interesting than on-campus interviews were the off-campus second rounds, where I got to meet candidates from other business schools. For the healthcare companies that I interviewed with, it was great to see that Duke always had a good representation of candidates and that we were one of the preferred school for many of these firms. This means that the Fuqua network in the healthcare industry will continue to expand beyond rivalry, and I look forward to being part of that network in the future!

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HSM on Exchange: Field Report from South Africa

Tarika MansukhaniToday Ross Beerman, Managing Director and co-Founder of AllLife sat down with an intimate circle of students in the library at the University of Cape Town Graduate School of Business to talk about the company he started in 2004. While the name and even font in the logo suggests that AllLife is an old and traditional insurance company, it is really an innovative business model providing affordable life coverage for individuals living with HIV in South Africa. Over 10% of South Africans are HIV+, and most managed care companies immediately shy away from this group. Ross explains that the messaging around HIV in South Africa is generally “HIV = Aids = death = Use a condom.” While this certainly drives prevention, it does nothing to promote positive behavior in HIV+ patients who feel their life is over, a feeling affirmed when you can’t access insurance.

Ross’ team approached this problem by disregarding the age old insurance mantra that past behaviors drive those in future. They simply set out to change behavior, by changing the message HIV+ patients hear. While the average managed care company considers 75% adherence a success, AllLife now boasts 98% adherence rate for their lives under coverage. AllLife uses a system driven approach to create a high-touch, low cost model. They link to existing electrical medical record (EMR) systems in South Africa, and in doing so successfully track all their lives and use and strict monitor and reminder process to motivate their customers. When a patient is non-adherent they are immediately made aware of negative consequences to their policy, making it a very transparent and informative system that keeps patients involved. Ross explained that cost of healthcare is rarely an issue, as customers can access free healthcare in South Africa, and medical aid will cover the basic tests or treatments AllLife requires. They don’t use highly skilled staff, just data, IT and a system driven approach to create high-touch interaction with customers in an affordable manner. Ross says that people often think it’s about an emerging markets story of success because it’s South Africa, but he insists it’s a solution taking advantage of available first world technology.

I found this is particularly interesting, since I wasn’t aware that South Africa’s EMR system was that far advanced, especially given the host of trouble we’re having implementing it Stateside. Ross explained that they have similar issues here, and challenges with EMR platforms being compatible across hospital systems, but AllLife’s software serves as the technological link between all of them (there’s hope after all!). This makes it possible to track patient behavior everywhere, and also what makes them so uniquely able to provide their solutions at a low cost, something absolutely necessary in emerging markets. While the story of launch and success is more involved, Ross offers a great example of leveraging existing strengths in resource poor developing countries as a solution. He even mentioned they’ve recently begun coverage for patients with diabetes and will shortly begin pilot programs to test success of coverage. Certainly any success in improving patient adherence in this area could be a valuable lesson exportable not just to other developing countries, but back home as well.

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From Finance to Healthcare: Successful interviews require thorough preparation

Trevor JohnsonSix months of networking boiled down to two 45-minute interviews with the opportunity to secure a first year’s most coveted prize – an internship offer.  This was my experience this past January in interviewing for the offer I eventually accepted with Johnson & Johnson Ethicon.

Preparation was the most critical component to my successful interview process.  I found that doing my work on the front end of the process was key.  That was the time to develop my STAR stories (Situation, Task, Action, Result) and to articulate my thoughts on general questions such as strengths and weaknesses and career ambitions.  By doing my work upfront, I had a lighter workload when interviews actually arrived, as my preparation then simply involved tweaking responses for particular companies and industries.

Networking was also critical in helping to ease the process.  Networking allowed me to demonstrate my talent and personality over a longer period of time than just the hour or so I was in an interview, and helped me hone the reasons I was interested in a company and industry.

On top of this preparation, I also utilized a number of resources at Fuqua.  Beyond the resources of the staff in the Career Management Center, every first year is assigned a second year Career Fellow to guide them in their preparation.  My Career Fellow interned at a company I was very interested in, so she was instrumental in helping me to network with the company and tailor my resume, cover letter, and interview material to that company.

I also conducted mock interviews with my Career Fellow through the MBAA (Fuqua student government) and through the Health Care Club.  The MBAA arranges for companies to conduct mock interviews with students in December, and fortunately I signed up in time to get a mock interview with Ethicon.

The variety of programs held by HSM and the Health Care Club to discuss current topics in healthcare also prepared me for any technical healthcare questions.  This was especially important for me as a career switcher, coming out of finance.

All of this preparation, facilitated by Fuqua, allowed me to find success in my real Ethicon interviews and to feel confident during an otherwise awkward and intimidating process.

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HSM Bootcamp: Launch pad for the HSM experience

Steven MaDuke MBA students who are also part of the Health Sector Management (HSM) program arrive on campus a week early for an intensive, 5-day, healthcare bootcamp. It serves as a primer of the US healthcare system and is the launch pad for our entire HSM experience. Half of the HSM folks do not come from the healthcare industry. Even for those of us who do, most only have experienced one or two different areas of a very diverse industry. While I was familiar with pharma and biotech, I had much to learn on the provider, payer, and regulatory aspects of the US healthcare system.

I get asked this sometimes from prospective students – the HSM bootcamp and the HSM courses focus on the US healthcare system in general. Sometimes comparisons are made to UK, Canada, Japan, or China, but I’d say more than 90% of the time our topics focus on the US. However, we have classmates from all over the world who share rich healthcare experiences overseas. Also, the bootcamp amounts to 3 academic credits, so the hard work does end up paying off!

The bootcamp was a nice preview of the MBA experience, and I’m thankful for that – having been out of school for a few years. We began with a lecture at 8am after breakfast. After lunch, we had more seminars and a handful of external speakers that talked about diverse issues such as health policy, ethics, tech transfer, venture capital, and global health. In the evenings, we had a company-sponsored event and heard about post-MBA opportunities in these healthcare companies.

The fall terms were definitely fast-paced and many would consider it the most stressful period in the Duke MBA. During bootcamp, on 3 of the 5 days we left campus around midnight and had to get back for class at 8am. This was not something I was used to doing since graduating from college. Having the HSM bootcamp (and also the Global Institute) before the fall terms started was helpful in getting back to the academic mindset.

Another benefit to the bootcamp was that the 90 or so HSM students could meet and engage with one another before the entire 400+ class was on campus. Everyone was passionate about healthcare and I definitely learned a lot from classroom discussions, especially on the provider and regulatory aspects. After the entire first year class arrived, we were divided into 1 of 6 sections, so the HSM bootcamp gave us the opportunity to connect with folks across the different sections early on.

The HSM bootcamp provided a great overview and brought everyone up-to-speed on general knowledge of the US healthcare system. It is a rapidly evolving industry with many stakeholders and governed by powerful forces. Coming from an R&D background the bootcamp was a great primer to get a first look at some of the issues impacting the business of healthcare.

This post is also featured on my blog From Bench to Board where I share my experiences at Duke.  I am particularly passionate about those related to the MBA’s Health Sector Management program. Visit my blog to learn more!

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Blue Devil Weekend: An opportunity to learn more about HSM

Charlotte BuchananFebruary 7-9 marked the first of two Blue Devil Weekends at Fuqua, where we host admitted students for two-and-a-half days to show them what it means to be a part of Team Fuqua. While manning the Health Care Club (HCC) table at the student organizations fair, I had the opportunity to meet some of the Class of 2016 – and was wowed by the diversity of their experiences and interests.  An MD-MBA, a biomedical engineer, and a healthcare consultant were just a few of the people I spoke with, not to mention several industry-switchers.  That’s the great thing about the HSM program – you learn just as much from your peers as you do from your professors.  And you’ll be surprised at how rapidly you pick things up.

I remember meeting HSM students at last year’s BDW; an industry-switcher myself, I was impressed – ok, maybe a little bit intimidated – by the breadth and depth of their knowledge.  Now that things have come full-circle, I can reflect on how much I’ve learned about healthcare over the last seven months (a lot!) and how much I’ve enjoyed being a part of HSM and HCC.  We’re a tight-knit cohort, and though I’m definitely not ready to say goodbye to the second-year class, I’m excited about the next generation of Fuquans!

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Week in DC: An eye-opening experience into the healthcare arena

Saj JoyThis was my first HSM course and what an amazing start!  This week in DC course set high expectations and exceeded them all!  The diversity of speakers encompassed a wide range of healthcare leaders.  From being able to sit and have a fireside chat with Sen. Burr of NC at his U.S. Senate office to hearing presentations by Dr. Bilheimer from the Congressional Budget Office, a variety of perspectives were presented.  Speakers representing government agencies (CMS to the FDA), to insurance representatives (America’s Health Insurance Plans), to pollsters and lobbyist were included.  Private enterprise (Advisory Board to Private Equity opportunities) was also represented.  This was an eye-opening experience into the healthcare arena – very different from my perspective as a practicing physician.  This was truly a balanced week with something that would appeal to anyone entering the US healthcare space.

I would encourage anyone interested in the rapidly evolving US healthcare space to take advantage of this unique opportunity available to Fuqua students!

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Week in DC: Additional insight into pharma/biotech industries

Garrett GilesOur guest speaker from Breakaway Policy Strategies provided additional insight into the pharma/biotech industries and how drug costs, marketing efforts, and FDA activities are impacting the bio-pharma/med device landscape.  Some areas of interest included:

Although prescription drug costs get a lot of coverage in the media and even though prescription drug costs are growing, they are growing at a low rate of ~.5% and only make up ~10% of total healthcare costs. It is important to keep an eye on drug costs, but also wise to keep in context with overall healthcare spend and the areas where we can make the greatest dent.

Decision making power at hospitals and healthcare systems are being performed more and more by formulary and procurement officers and less and less by individual physicians. This is due to the consolidation of hospitals and acquisition activity in the space as well as more scrutiny of costs and prices of medications. From a marketing standpoint, this change impacts how effective DTC and sales force efforts are moving forward. The drugs that are able to find a place on the drug formularies are the ones that will benefit while those that aren’t as fortunate might find better use of marketing dollars elsewhere. For these not so lucky products, DTC marketing will be good for increasing patient awareness of a disease state and/or product, but won’t bear much fruit from an increased prescribing standpoint. Getting on the formulary has become king when it comes to doctors’ putting pen to pad.

FDA is beaten up a lot from all sides because it is either too rigid or too lenient, but at the end of the day, FDA officials are trying to do the right thing for both industry and patients. It is important to keep in mind the delicate balance between encouraging innovation and patient safety, both of which are incredibly important for our healthcare system.

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Week in DC: Controlling the cost of healthcare

Sara PtakowskiLoren Adler, a Research Director from the bipartisan Committee for a Responsible Federal Budget, discussed one of the week’s recurring themes, talking about the rising proportion of US GDP consumed by healthcare spend over the past 4 decades (currently 20%) and the implications of this escalation have on the government’s overall fiscal policy.  In fact, the 10 year cost of Medicare alone (a federal program) is the largest component of all healthcare dollars public or private. He demonstrated that at this rate, healthcare is beginning to crowd out discretionary government expenditures and the tradeoffs are becoming more explicit – forcing the government to choose healthcare over education, infrastructure, and the like.

Adler addressed the fact that there has been the slower growth rate in healthcare spend in the past 5 years. Yet while the trend is encouraging, the reasons for the slowdown are largely unexplained despite many efforts to do so. Potential explanations include the recession, a lack of new technologies particularly as certain blockbuster drugs are hitting patent cliffs, heightened consumer awareness with the proliferation of high deductible health plans, and overall structural changes to the way that healthcare is delivered.

Not all of these structural changes are created equal though – some are merely one-time cuts as part of the Affordable Care Act (ACA), while others like readmission penalties and Accountable Care Organizations (ACOs) may fundamentally change the delivery of care and reduce utilization. However, the longstanding fee-for-service model of healthcare reimbursement still incentivizes quantity over quality on the provider side. And on the patient side, a lack of true cost-sharing particularly in the Medicare system does little to discourage over-utilization. To curb further government spending on healthcare, the Medicare system would benefit from stronger ACOs and a move to a value-based performance payment program from the current Sustainable Growth Rate model.

All of these points serve to demonstrate that there is still a great deal of work to be done on truly bending the cost curve on healthcare in the United States. Without the ability to codify the reasons for the recent slowdown it will be difficult for payers, providers or the government to capitalize on and continue that trend.  While this has major implications for the healthcare industry in particular, from a policy perspective unchecked growth will be unsustainable without significant impact on other areas of the American government.

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