Embracing Opportunities and Being Prepared: Lessons from Dr. Lyle Berkowitz

Ed (00:00.91)
Hey, it's Ed, welcome to another edition of Digital Voices. Thank you so much for listening. I know there's so much great content out there. I listen to a lot of different podcasts and you've chosen to spend time with us and we're gonna make it worth your while because I have Dr. Lyle Berkowitz as our guest. Lyle, welcome to Digital Voices.

Lyle Berkowitz (00:19.943)
Hey, thanks, Ed. Looking forward to it.

Ed (00:22.126)
Yeah, this is super fun because you and I go way back. We couldn't really figure out how long. We probably don't want to know really how long, but we've interacted, known each other, Facebook friends for many, many years. So I'm guessing probably 20 years. What do you think?

Lyle Berkowitz (00:31.207)
Yeah.

Lyle Berkowitz (00:39.303)
Yeah, it's funny, right? The industry makes a lot of interesting connections over the years. And I tell my son, right, you know, the people you're going to meet now in your 20s, you don't know what's going to happen, but be assured some of them will pop up in and out of your life for years.

Ed (00:51.342)
Great.

Ed (00:55.47)
Yeah, so treat everyone with kindness. So the most important question, Lyle, that we ask every guest is what are the songs on your playlist? So like when you have downtime, what do you like to jam to?

Lyle Berkowitz (01:11.239)
So, you know, and this may come up later. I don't do a lot of downtime, you know, so I, you know, I'm old school. I like, you know, my Billy Joel, Simon Garfunkel, Kat Stevens, The Stones, Bowie, you know, some alt rock like Green Day, et cetera. And, you know, I'll listen to whatever's popular on there, but I am, I'm not a music head. So not, so not as great an answer as some will probably give you.

Ed (01:15.662)
Yeah.

Ed (01:37.934)
However, I know it's not related directly to music, but I know that you've spent many years as a physician consultant to a wide variety of movie and television theatrical productions. That's super interesting. Tell us a little bit about that.

Lyle Berkowitz (01:53.863)
I'll make it even more fun.

My dad, who was a primary care doctor in Chicago, did it for 25 years and passed it on to me. So I was going to movie sets as a kid with him. Together, we took care of most of the major movies and TV shows in Chicago for 50 years. So we have a lot of stories. So we would get, they would come to our office, we would get called to the set. And yeah, lots of stories I can't talk about, but absolutely fun. I've always loved movies.

TV, etc. So it's been fun. My dad had me act as an extra. He set that up when I was a kid. So I've seen it from all sides. It's much more fun to be the doctor walking in. You have this prominence on set when you walk in with your little doctor bag, half the time just giving vitamin B12 shots, but sometimes really helping save the day now and then for a sick actor, director, etc.

Ed (02:46.798)
Yeah.

Ed (02:53.262)
Yeah, that is so cool. Yeah, someday offline, you'll have to regale us with some super interesting stories. What about your life message and mantra? I know you have a website and I saw a lot of great quotes and messages on your website, but what's one that really helps kind of drive who you are?

Lyle Berkowitz (03:15.143)
I love a good quote. I've got a couple, but one certainly I'll often give out is chance favors a prepared mind. A lot of people say, you got lucky or this happened same time, but.

People often don't fully embrace how important luck is and timing. And a lot of people work hard. Why do some people succeed? Sometimes it's just, it's a combination of things, but it is, I love, and this was a Louis Pasteur quote, chance favors a prepared mind. We all have luck coming and universe conspiring every single day, but if you're not prepared to accept it, embrace it.

Ed (03:48.302)
Yeah.

Lyle Berkowitz (03:53.479)
and take advantage of it, it's going to pass you by. And so when people say, I don't have luck, I'm like, you probably had it, but did you prepare for it and did you take advantage of it?

Ed (04:03.662)
Yeah, that's true. That's a good mantra and words to live by. Tell us a little bit, and we already broke one of the headline stories about you and your dad and working on movie sets and things like that. But tell us more about your personal story, both personal and professional. You can start as young as you want and take us all the way to present day.

Lyle Berkowitz (04:25.895)
Yeah, so son of a doctor, right? So I grew up in and out of the hospital and, you know, just understanding that type of thing. I always thought I wanted to be a doctor, but I also had a bit of a technical mind. I was a kid. I loved computers, trained on BASIC and FORTRAN, did programming. Yeah, I was at the right time. Punch cards were over. I didn't have to do punch cards. I had a personal computer and one of the early computers that I was able to buy, high school.

Ed (04:49.742)
Yeah.

Lyle Berkowitz (04:55.623)
computer programming. So I actually became an engineer, a biomedical engineer. I honestly thought I was going to create the next Bionic Man. I love that TV show. And I was like, I'm going to learn electrical and biomedical engineering and be a doctor and like build the Bionic Man. Turned out I was not great at mechanical and electrical engineering.

but I was really good at computer engineering. And I had a minor in chemical engineering, which was really a lot of math, et cetera. And we all did computers. And had a second where I thought I might go into pure engineering, but knew I wanted to go to med school. Wasn't sure what I'd do. In my final year of undergrad, I worked for a doctor who was doing what was sort of early medical informatics stuff. This is in the 80s. And he introduced me.

as often luck will have it to someone at the med school I was going to, University of Illinois. I was at Penn undergrad, University of Illinois med school. And he said, meet this guy, Arthur Elstein. He's a PhD, but he's into medical informatics, which I had no idea what that meant. But all of a sudden, 1988, I'm his research associate. And he becomes my mentor, teaches me about the science of decision making, use of computers, gave me a lot of leeway to do a lot of stuff. And so I'm learning.

doing research for him and recognized this is my career. I knew early in my life in med school, I wanted to be somebody who could be a doctor but could also apply technology and computers into medicine. And in the late 80s, early 90s, like that was considered foolish. But I knew that's what I wanted to do. So it was easy enough. And I did my residency at Northwestern and internal medicine primary care, joined a group there. I said, can I be the director of IT?

It's 1995 and my mentor friend, Dr. Cobin said, why would you want to do that? He's the chief medical officer of the group. And I said, I think it'll be important. He goes, fine, Lyle, you can have 20 % of your time to do that tech stuff. Maybe we'll need it. And I learned all about physician adoption by actually convincing my doctors to get a computer, just to use email and other stuff. But I started studying electronic medical records and I went to some dinner.

Ed (06:47.054)
Yeah.

Ed (06:51.79)
you

Lyle Berkowitz (07:14.983)
by some EMR company and by the end of the dinner I'd asked so many questions they said do you want to be our chief medical officer so right chance favors a prepared mind I'm like sure what does that mean that was really important because all of a sudden I'm doing that part -time practicing part -time I'm learning about you know what is you know what it is to be it's a publicly traded company learning about what that means from a business perspective I'm learning about project management and

Ed (07:24.622)
Yeah.

Lyle Berkowitz (07:43.143)
all of these interesting things really early on. And that went on, then I wound up working in another company as chief medical officer. So during my course at Northwestern, I was a physician who on the side did a variety of business jobs. And eventually as an executive at Northwestern, I did director of IT, I rolled out EMRs first Cerner then Epic. And then I spent about a decade doing that, another decade.

setting up our innovation department, really learning about innovation nationally in healthcare. I wound up writing a book about that on the intersection of IT and innovation in healthcare with a good friend of mine and a mentor of mine, Chris McCarthy. And I just was an advisor and sort of starting companies. I started Healthphinx based on some ideas I had as a refill automation company, a workflow automation company. I started a bunch of other companies that didn't work.

Ed (08:41.39)
Yeah.

Lyle Berkowitz (08:41.895)
I advised a bunch of other companies, became the board member for OneView, which was a public trade company. So I just, I had a fun, varied career. I left all that at the end of 2017 and joined MDLive, one of the big telehealth companies. Really was the first time I had a single job focused as chief medical officer over operations, but also EVP over product and strategy and learn, learn, learn as we scaled, sold that.

to Cigna eventually sold HealthFinks to Catalyst. Was, started just investing, became an investor for a little while, a consultant, but as we'll hear later, wound up starting Keycare in partnership with Epic as during COVID, a clear new idea, old idea combined together to say, what if we created a telehealth company, but built it on the infrastructure that a majority of health systems use rather than start from scratch.

Ed (09:37.166)
Yeah, well, that's an amazing career. That's why I've always liked you. I've always loved our interactions. You're always so creative and energetic and passionate about.

Lyle Berkowitz (09:44.679)
Well, one, I can't keep a job and I just keep stumbling into stuff. And again, chance favors a prepared mind. I've been lucky, Ed, and I've had some great mentors and great people who've helped me along the way, like we all have.

Ed (09:57.326)
Yeah, yeah, no doubt about that. What would you say out of all those roles? And maybe there's a one that you didn't mention maybe when you were a teen, I don't know. But what's been the most informative? Like, I know it's hard to pick one because you've had such a great career thus far. But what would be one that you'd think that really helped me the, you know, took me to the next level?

Lyle Berkowitz (10:18.279)
I mean, as a doctor, right, your third year of medical school, you go from dry book knowledge to taking care of patients. And so much of who I am and what I am is about that year is the most intense year of anyone's life. We don't talk about much, but that is the year where you literally start taking care of patients and you learn so much and you see so much. And not only did I learn as a doctor, but as an innovator because...

Ed (10:38.862)
Yeah.

Lyle Berkowitz (10:44.967)
I often question stuff. I'm an engineer and we're always asking, how can it be done better? And what I learned early on it was some doctors, senior doctors really appreciate that. Wow, that's a really good question. Let's think about that. Maybe we could do it better, et cetera, and encourage that. Others were like, shut up, you're being stupid. We do it this way. Don't ask, don't question. And, you know, it's a tough world out there and innovation is really hard. And I knew one of the other,

sort of mantras I tell my kids, I tell people is you can't please all the people all the time. If you're gonna be an innovator, if you don't piss people off at some point, you're not doing your job. You're not, if you don't make mistakes, upset people, you are not doing a good enough job of pushing the boundaries. And I learned that early on then I'm from a business perspective. I think my first job, my first role is chief medical officer at this advanced health company had a great mentor, this guy named Rob Algers is still a friend.

teach me about the ways of business. And I think those two things combined and really, I was young enough as a doctor to challenge, why don't we do it this way? And that stuck with me. Why don't we just make technology make our lives easier as physicians? And that will eventually make life better for patients as well. And it's really much of the mantra of how I design a lot of what I've done.

Ed (12:09.774)
Yeah, I love that. Those are two super important things, Lyle, and I just want to call them out. But you challenge the status quo, and you can't please everyone because then you won't fulfill what you've been called to do. Those are my words. But you've got to be sort of a little bit of a rebellious spirit in order to really move things forward. So that's what I appreciate about you and how you've done so much for health care and the tech side of it.

bringing together all that engineering and tech understanding and the physician component. Yeah, let's jump into Keycare. So, so interesting. Share the Keycare story. So for those who don't know, tell us about Keycare, how it started and what it does.

Lyle Berkowitz (12:53.735)
Yeah, so Keycare is a national telehealth group company that works on Epic. So imagine if you had a national medical group, primary care medical group, that's all virtual and we use Epic. And we are optimized not just for doing virtual care, but for doing it in coordination with our nation's health systems. So we look at ourselves as we're building up a tech enabled virtual care team.

We have our own instance of Epic and that allows us to therefore connect to all the other instances of Epic. Epic, as you know, is 60 % of health systems are on Epic. 75 % patients have some data on Epic. So when we see a patient, a lot of times it's in partnership with a health system, we are partners with them, we're co -managing those patients, they're sending the patients to us. We do 24 by seven, 50 state urgent care. So we can see that patient.

We have all their data from the health system. We take care of the patient and then we send it back with all the data back. It's a higher quality experience. It's a more seamless experience for patients and the doctors, the officeologist, the doctors in the health systems who are in the offices, they get to share in all the data. We started with urgent care. We're expanding doing primary care. And then we are partnering with other specialty care groups to also sit on our instance of Epic.

to support the health systems in particular. And the result is we've now taken care of patients in all 50 states. We have helped health systems improve access, because that's our core purpose of being, is to improve access to healthcare. But to do it in a coordinated way with health systems, and a lot of times, I'll suggest we are not really a telehealth company. We don't sell any technology. We sell access to this tech -enabled virtual care team.

and I look at us as a population health enablement team. We help you, health system, manage your population and we focus on doing highly efficient online work for the routine patients that are often what I call the triple R threat that are overwhelming our doctors, routine repeatable rules -based care. Doctors love acronyms, so that's my RRR. And I'm like, what if we could shift some of those online?

Lyle Berkowitz (15:16.711)
Because you, health system, you lose money taking care of those patients. They're not high value. They're just quick visits. We'll do it online. Patients prefer that much of the time for their routine issues as long as they know they can get in for the more complex issues. So we are a physician amplifier in that we build teams. The concept of population health, of team -based care, that is not new. We're simply enabling it in a way that we can execute in a scalable fashion. And...

provide an option for health systems who want to be able to provide more access, but don't necessarily want to do it all themselves because they've got better things to work on.

Ed (15:55.054)
No, I love this. And as you said earlier, chance favors prepared minds. So you had this experience working with an EMR company long ago, then MDLive. And so you're able to take all this knowledge and experience and help create something new. I think you were talking earlier about, you know, sort of the old, melding the old with the new and creating something that helps people. So awesome.

Lyle Berkowitz (16:18.855)
Yeah, it is. It's my health system experience, my epic experience, my national telehealth experience, my startup experience, and none of it matters except for one thing, COVID. None of it would have mattered if not for COVID, all of a sudden making telehealth, particularly at health systems, extremely important.

viable. And as they say, genies out of the bottle, all of a sudden patients realize, well, this actually makes sense to do virtual care for routine stuff. And health systems and doctors realize this, this actually does make sense. But now that we're getting past COVID, the office based doctors, the officeologist, as I call them, they are getting back to just doing office care. So some people would say, we're seeing telehealth go away. Volumes are going down. I'm like, no, volumes are going down because doctors in the office don't want to do it anymore.

because quite honestly, they're optimized in the office to do it. It's a cognitive dissonance to do a bunch of different types of care.

Virtualists are the new wave of types of doctors, just like hospitalists rose in the 90s, we're seeing virtualists now. And the idea is, again, without COVID, I would not have even thought about starting this company. And with COVID though, an opportunity presented itself. And the fact is also Epic has become the mainstay. 10 years ago, Epic wasn't as wide, but now it is. Also in the past 10 years,

Ed (17:23.246)
Yeah.

Lyle Berkowitz (17:48.345)
built out the interoperability because to EPIC it was really important that if a patient is seen in one EPIC instance and goes to another that all the data is shared. They created care everywhere their data interoperability schema that is yeah I think if I recall they exchanged 15 million records a day.

And they've furthermore built what we'll call workflow interoperability tools that allow, for example, for cross -instance scheduling. They can use direct messaging and other things to allow us to order within different systems, to do referrals across systems. They've really built up these tools to allow two epic instances to talk and work with each other. Let's face it, most health systems don't want to do that necessarily with each other. We become the independent Switzerland that can help health systems in a way

that doesn't feel competitive because we have no physical space in offices.

Ed (18:40.398)
Yeah. And it's the best thing for the patient and the clinician. So no, that's awesome. You mentioned Epic a couple of times. So that's sort of a unique thing as well. I think you're probably a pioneer perhaps in developing the kind of partnership that you have. So how did that come about?

Lyle Berkowitz (18:45.895)
Mm -hmm.

Lyle Berkowitz (18:59.879)
Well, like a lot of things, it's about relationships and trust. At Northwestern, I helped roll out Epic to our primary care group, and so spent time with them there. When we built HealthFinks, we initially had a little conflict. Instead of saying, no, Epic's going to do something similar, I sat down and I said, well, how do we help each other? We both want the same thing.

How can we work together? And Epic said, great, this is how we can work together. You focus on this, we'll focus on this. And I was also promoting this concept of an app. By that time, Healthfinch had won best app award on Allscripts, on Athena, and Epic was coming up with an app orchard idea. So we said, why don't we make this the prototype of what it should be like? We became one of the first apps. We were based on Madison. My co -founder, John Baron, was CEO. He worked with them, and we became one of the first apps.

apps on their app orchard. And again, we learned how to trust. We had common goals, which was to make life easier for doctors.

Ed (20:01.326)
Yeah.

Lyle Berkowitz (20:04.071)
and better for patients at the same time by automating routine repeatable workflows. So that became a very successful project. And then after I was done with my other companies, I told Epic, I said, hey, we got a national emergency. What can I help you with? I just went to them with open arms and say, how can I help you understand virtual care telehealth better? I'm here just as a servant because this is a national crisis and you guys are out there.

building up your telehealth system. And one thing led to another and we said, well, yeah, it would make sense to have a medical group that was on Epic doing telehealth using all of these things. And I just, I knew how it would all work. And I said, what do you want me to advise you on doing it? And they're like, we're a tech company, we don't do services.

And I said, well, will you let me do it, you know, where I buy my own instance and I have to raise money and all this stuff. And they, you know, it wasn't overnight, but, you know, we sat down and said, well, this makes sense. We have a common goal. We want to see improved access via virtual care at the health systems where all the data is because to see patients go to these isolated telehealth vendors to get care done with no coordination with the health system is just not good care.

And I'm a health system guy and I'm a tech guy and so it just all made sense and it was as simple as that.

Ed (21:31.726)
That's awesome. Before we sort of dive into leadership Lyle, because obviously you're a great leader. Can you share maybe just one story of a patient or a clinician's success using Keycare?

Lyle Berkowitz (21:46.887)
Yeah, so we've got a couple of great stories. Our friends at WellSpan, you know, Hal Baker, perhaps, who's a physician and the Chief Digital Officer at WellSpan, one of our earliest clients and users. What they have done is partnered with us so that we can provide this 24 by 7 virtual urgent care.

they furthermore, we actually work with them to credential our providers into their system. So we assign the billing. So all the patients that we see can be billed by the health system because we're working so collaboratively together. And so we've made not only access to care, but we've made it affordable. And we've started replicating that with other health systems. Similarly at Memorial Health System down in Florida,

One of the first things they wanted to focus on was their employees and sponsoring care for their employees because they know that whereas with WellSpan, it was about increasing capacity, increasing the funnel, the more patients you take care of, the better. At Memorial, the employees, they were self -insured for, so they knew anything that could decrease ER visits and office visits by getting appropriate virtual care was going to save them money, decrease lost work days, et cetera. And so...

Both are great examples of how we created not only access but affordable access and it had benefits in a variety of different ways.

Ed (23:12.782)
Yeah, those are, those are amazing examples. Yeah. So let's switch to leadership. So you, you mentioned when you were telling us your story that you've been part of many startups, including key care and some didn't work some work. So what's your single best piece of advice for an aspiring inventor or, you know, someone who's trying to do a startup.

Lyle Berkowitz (23:34.759)
Well, to really understand incentive alignment, when I was sitting as a leader in innovation at Northwestern and a new startup would come to me, the first thing I'd say is answer three questions. One, who has to literally use you? Does the doctor have to use you, spend a minute, is it a nurse, is it an automatic? Two, who pays for it?

You know, is it the payer? Is it the doctor who pays for it? And three, who benefits from it financially? And then show me how those things are aligned. And it is shocking how often they would come and they say, well, it just takes the doctor an extra minute. yeah, the doctor would pay for it. And the patient benefits like who financially benefits? Well, the payer would benefit. I'm like, how does that align? And they're like, you know, there's 25 year old kids who've had some cool tech and they're like, well, but it's just the right thing to do.

Ed (24:21.39)
Yeah.

Lyle Berkowitz (24:28.583)
If this was available, my aunt would have had a better experience. I'm like, this is not how the world works. Healthcare is hard. It's a multi -prime system. And if you don't understand how to align the right thing with financial incentives, you're not going to get adoption. And if you're going to ask a doctor to spend a minute extra when they have limited time and they don't have a huge benefit from that, that's a problem. I always worked on how do I take

time off the plate. So Healthfinch save the doctor 30 minutes a day. The doctor will pay for that. Keycare ideally is making, not just making money for a health system, but is taking what I'll call this routine work off of a doctor's plate. We are gonna talk at some point about physician incentives because that becomes an issue. So right now we're really well aligned with the health systems and or the payers and they're the ones who would be paying for it.

Ed (25:02.574)
Yeah.

Yeah.

Lyle Berkowitz (25:27.783)
But to get wide adoption, physician adoption, you have to make it easy to do the right thing and you have to make sure incentives are aligned.

Ed (25:34.958)
Yeah. Those are, those are good, good three questions. And you mentioned a couple of times Lyle that your success has been predicated on building great teams. What's the single most important criteria you might look at in a potential team member?

Lyle Berkowitz (25:49.767)
You know, we have a couple of behaviors that are looked at. I think the common answer for a startup is often grit, right? You know, that nothing's gonna stop. I mean, having the passion and grit to just keep moving forward. One of my innovation mentors, a guy named Peter Salozzi, he was a patient of mine who really inspired me, he would often say, don't tell me what you can't do.

And what I find is when I hire people who come out of health systems or large corporate jobs, and they say, I want to be in a startup. I love startup. I've always feel like I'm constrained. And yet they come in and they can't help themselves. They focus on what they can't do. I can't do this. They won't do that. Listen, don't tell me what you can't do. Show me the stuff. Tell me what it will take. I'd rather you come with 100 crazy ideas than...

100 reasons why you can't do something. And so it's just, it is, and it's really hard because people, they believe in themselves that they see a TV show and they think that startups are all fun and donuts and everything. And they don't understand it is up and down every single day. Every single day, something great happens and something horrible happens almost every day. And you got to the grit to just say, I've got my mission, I got my passion. I'm just going to keep moving forward.

Ed (26:46.51)
All right, yeah, that's good.

Lyle Berkowitz (27:12.647)
and I'm going to continually figure out how to problem solve this.

Ed (27:17.358)
So people listening are probably like, okay, family man, entrepreneur, startup, physician, how do you integrate your life? How do you get downtime? We touched on it in the very beginning. What do you do to rest or where do you get replenished?

Lyle Berkowitz (27:35.687)
So the good thing is I'm a workaholic. It's funny because, yeah, work like that. Fuck it. I don't work like that. I work. I love work. That's how you're going to succeed. You got to work hard. And it's wonderful to see these people. I run marathons and read books. I'm sorry. I can't do that right now. Maybe someday. With that said, do I love to golf? Yes. Will I do downtime? I usually do this. I work all day until about five or six.

Then I take a break, dinner, maybe go out, maybe do something, refresh, maybe watch TV, go for a walk, et cetera. And then I'm back at it about 11 o 'clock at night. I've got, for whatever reason, my energy is high then. I'm not an early riser. I'll get up at seven or eight, but I'm not one of those guys who gets up at 430. I know you run, I mean, you do some crazy stuff and good for you. I am such a...

Ed (28:17.13)
Yeah.

Lyle Berkowitz (28:31.463)
I don't feel like I work. I'm having the best time of my life. I love everything I've done. If I don't like it, I quit. Yeah, I hate to say quit, but I changed my job. I changed my job about every five years. That is my refresh. With that said, I wish, wish, wish I had taken some more time off. I wish my health system had said, well, after five years, take a month off, go refresh, et cetera. It's been a constant grind. Unfortunately, I like it, but.

A good vacation now and then makes a world of difference to me. I probably should exercise more, et cetera. But I don't, I don't like it. I love working. And so I just will keep going to that.

Ed (29:07.906)
Yeah, that's good. That's what they say. I'm going to get the quote wrong, but you know, you never, if you enjoy what you're doing, you never work a day in your life or something like that. but I'm the same way. I love, I love what I do. I love, I always have. And so I love working. I never felt like I was like, overburdened or anything. Lyle, this has been fantastic. We covered so much ground, in 30, in less than 30 minutes.

Lyle Berkowitz (29:20.455)
Yep. Yep.

Ed (29:34.926)
And it's great to get to know about you and some of the fun things about your life, you know, with all the movies and things that you helped out in Chicago there, and then just your whole education process and your thought process about discovering ultimately what you want to be. And then we talked a lot about your career, because I think that's super helpful to everyone listening. And then Keycare, learned a lot about Keycare and the partnership with Epic. And we talked about leadership. I think your three questions are great for any startup.

and talk about teams and inspiration, all sorts of stuff. What did we miss or is there anything you want to double down on? I'll give you the last.

Lyle Berkowitz (30:11.783)
You know, I think we, let's step back. We need to rethink redesigned primary care. I exist in this world because at 20 years old, I read some book or something that said, hey, if you want to be happy for the rest of your life and your career, pick a goal that you'll probably never truly achieve because most of the fun is going after. And that goal was improving health care as a whole. And.

It was a good one because we're never going to really achieve it. But I am a strong proponent of primary care redesign and not crazy stuff. It is all again, pop health, team -based care. What I find is though people, I think mistakenly look at value -based care and say, well, I can only pay my doctors a value -based way if we make money in a value -based way. And I'm really, I'm working on a paper right now to

talk about, we have to rethink how we pay doctors. Primary or physician compensation redesign. I for whatever reason, I've always been on every physician comp committee in whatever job I've been in. And I think if you, again, incentives matter, whether you think they do or not. That's my MBA in a box. And I want to see what happens if you pay physicians to manage a population. I don't care if they're making

if they're getting paid fee for service or your health system's fee for service, you can pay physicians how you want. And if you can pay them to manage a population and give them a team, and what I want to do is give them this tech enabled team. I think right now we say that a typical PCP can see maybe 2000 patients max. That's typical. And by the way, they do a lousy job. Studies show 50 % patients get about 50 % recommended care.

So then they're like, let's just do concierge care and everyone see 500. I'm like, how does that make any sense in a world where we don't have enough doctors with that system? We have to figure out if we're going to fix this system, that how does a single doctor manage 5 ,000 patients and do it in a way where their life's actually easier. And that's where what I'm focused on, technology and team -based care. How do we get someone instead of seeing me Dr. Berkowitz all the time?

Lyle Berkowitz (32:27.847)
How do we say, you're gonna see Dr. Berkowitz's team? And I've done a little, and patients love it. They're like, great. Your team will take care of the easy stuff, but when I really need Dr. Berkowitz, I can see him. And if we can pay the doctors based on their panel size, which I've been involved in that in the 90s when we did capitate care, all of a sudden I'm much more amenable to sharing the care with the team, doing more virtual care, et cetera. So we have a, I often will say,

We don't have a shortage of physicians. We have a shortage of using them efficiently. And when I look at technologies that say, hey, we're going to help you see one extra patient a day and therefore pay for ourselves. I'm like, that's nonsense. That is what's driving doctors into burnout. We need to go to doctors and say, hey, instead of seeing 25 patients a day, you're going to see 12 patients a day, but they're the ones who really need you. And your team is going to manage 50 patients a day.

Ed (33:23.758)
Yeah.

Lyle Berkowitz (33:24.039)
and for the easy stuff and they'll escalate to you when needed. We have to rethink how we take care of patients and it's not rocket science. I'm trying my best. This is my last hurrah to do it. And if I can do it, I'll feel like I've completed my arc of doing the best I can to make the health system better. And because sooner or later I'm going to need it since I have no work -life balance and barely exercise. But that's my final thing is,

Ed (33:48.75)
Yeah.

Lyle Berkowitz (33:53.031)
Remember, we don't have a shortage of physicians. Stop listening to people say that. We have a shortage of using them efficiently. We have a problem we can solve, and it's not going to be by making it. It's like saying, let's make more bank tellers because we don't have enough ATMs. It doesn't make any sense.

Ed (34:01.678)
Yeah.

Ed (34:10.926)
Yeah. No, that's a great way to end this episode. Lyle, it's been a pleasure just catching up with you and having you as a guest on our show. Thank you.

Lyle Berkowitz (34:23.143)
Thank you and thanks for all you're doing. I've always been inspired by you on a number of different levels and appreciate the discussion and talk, et cetera. And look forward to seeing you, I'm sure, in the near future.

Ed (34:35.054)
Yeah, in person. And that wraps up another edition of Digital Voices.