Think Like a Rookie

The following is the transcript of my appearance in November 2020 on the Osmosis.org podcast with Shiv Gaglani

While building her own successful career in the health insurance industry, Beth Bierbower developed a passion for being an advocate, mentor and sponsor for colleagues, especially women, in their pursuit of professional development. Not wanting her recent retirement to put an end to that role, she started her own podcast, B-Time, on which senior executives and founders of startups share insights from their leadership journeys as well as insights on business trends. In this enlightening conversation with Shiv Gaglani, Bierbower boils down key lessons from her own journey including the importance of knowing yourself — both strengths and weaknesses — in order to optimize your potential, being a “go-to” person and joining cross-functional teams, and never losing a personal growth mindset. Or as she puts it, “the minute you think you’re the smartest person in the room, you’ve stopped learning, and that’s a problem.”

Transcript

SHIV GAGLANI:
Hi, I’m Shiv Gaglani, and today on Raise the Line, I’m happy to be joined by Beth Bierbower, a longtime senior executive at Humana, who focused on innovation in various parts of the business. She was also known at Humana and beyond as a champion for women, serving as a mentor, sponsor, and advocate in the workplace. Beth has also established herself as a thought leader around emerging consumer healthcare trends, and has her own podcast called B-Time, which solidifies that role. And I’d also like to thank Osmosis advisor Bunny Ellerin, who was also a guest on Raise The Line, for the introduction to Beth. Beth, thanks so much for taking the time to be with us today.

BETH BIERBOWER:
I’m happy to be here. Thanks for inviting me.

SHIV GAGLANI:
So can you first tell us a bit more about your background beyond what I’ve said there? How you pursued your career within healthcare, and then most recently the launch of your podcast. We’d love to hear about it.

BETH BIERBOWER:
Sure. I’ve been in healthcare over 30 years, sort of fell into it by accident. It was a summer job while I was coming to college. I started with a medical assistance HMO, and two years after I graduated, I ended up with an HMO again that became a part of Coventry, so I was one of the first 20 employees with Coventry healthcare, that has since been acquired by Aetna. And then I’ve worked for Highmark Blue Cross Blue Shield, and then I spent 19 years with Humana, which I retired from at the end of last year. Because I’ve been in the industry so long, I’ve really been very fortunate that I’ve held a variety of positions. I’ve done everything from probiotic contracting to operations, to innovation, and it’s really given me a nice, broad view of the healthcare ecosystem. As I mentioned, I retired at the end of last year and when I was at Humana, I spent a lot of time helping our associates focus on career and professional development.

I thought, “How am I going to continue to interact with folks once I’m gone?” So I thought that maybe a podcast would be a good way for me to continue to bring learning to those people that I really, really care about, which are people in the industry that I’ve met over the years. So, I tap into my network, and people have been extremely gracious and have come on the show. I interview senior executives and founders of startups, and we talk about business trends, and insights, and leadership journey. It’s just a platform for people who really want to invest in themselves and their careers, and take a little time out and learn.
 

SHIV GAGLANI:
That’s awesome. And that’s definitely been our experience here at Raise the Line, as well, is you get to meet a lot of very interesting people. And the most fulfilling thing, apart from meeting with those folks, is hearing more about their careers, but also where they see the next few years going. It’s hard enough to predict the next week in these days of the COVID pandemic, let alone what the next few years are looking like. You are, I think the most experienced guest we’ve had in from the payer side of things. I would love to hear more about the evolution that you’ve seen over the years you’ve worked in the payer system and then moving forward, what are some of the major things you’re thinking will happen in a post-COVID world with regards to the payers?
 

BETH BIERBOWER:
Well, when I started out, it was with a managed care organization. So there really was a strong focus on prevention, and starting to have that care coordination. But what I’ve really seen us shift is more in that direction, over the years, really trying to put the patient — or the member, as we refer to them in the payer side — at the center of everything we do, and worry less about the claims transaction and focus more on the clinical interactions. The engagement, the interventions.  Shiv, as you know, as an industry, we’ve gotten smarter in total, and now we’re focusing on things like social determinants of health and behavioral health, and really starting to look at the consumer much more holistically.


So, it’s really been great to see that shift over time from insurance transaction — “What’s your ID number?” — to really beginning to understand what’s going on with that person? What are the determinants that are impacting them? What context do we really need to think about when we’re dealing with an individual, and really trying to help them achieve or maintain optimal health?
 

SHIV GAGLANI:
The consumerization of healthcare has definitely been something we’ve been tracking, and the expectations around healthcare have changed a lot. I think COVID, from our perspective, has made people very interested in the fact that, “Hey, just because I lost my job, why do I have to lose my healthcare?” What do you think consumer expectations post-COVID will be like? And how should health plans and providers react to those?

BETH BIERBOWER:
That’s a great question. There are a couple of things that I’m seeing from a consumer perspective. Safety is paramount. So, consumers will be worried about safety for some time to come. Telemedicine will be something that providers need to continue to embrace moving forward. As an example, my father-in-law is 91 years of age, and we’ve moved all of his routine appointments to telemedicine. The one physician that said, “I don’t do telemedicine,” we replaced because we weren’t going to have a 91-year-old traipsing into a doctor’s office to have his blood pressure taken, right? Because obviously he’s considered very, very vulnerable. So, I think telemedicine is going to be really important from a safety perspective. Then also the cleaning and disinfecting practices, people are really worried about that. I think people are just going to be much more alert to that as we’re coming into the fall again, flu season will be approaching soon.


The second thing, and you touched upon it. People have had reduced hours, they’ve lost their jobs. And I think financially, it’s going to take a while for people to recover, Shiv. It’s not going to be overnight. A lot of companies did a lot of great things back in March and April. Telephone companies said, “Listen, you have a grace period to pay for your mobile phone or your internet.” And of course, health plans stepped up, and waived copays and things like that. But I really think consumers are going to continue to need some wiggle room financially. So I would really encourage providers, health plans: how are we going to help a patient maybe find a drug subsidization program, right? For the specialty drug, if it’s $400 a month, how do they get it subsidized down to $20 a month? How do you give somebody wiggle room if they can’t afford their premium payment?


And then there are two other things I’d just like to raise real quickly. You mentioned one of them, consumer expectations. Your podcast is called Raise the Line. I’m going to play on that a little bit because the bar has really been raised here. Early on, if you think about grocery delivery as an example, it was sort of clunky. There were supply disruptions, but even within that, Amazon and others weren’t really performing well. And then they stepped up, and I’ll use Amazon as an example. Not only now can I order my groceries and have them delivered within two hours, they have the proper packaging. Everything’s sealed, so nobody’s in there rooting around, right? If you have something fresh or more fragile, they have extra padding. We’re not like that in healthcare, right? We don’t focus on the consumer.


But now that they have these expectations, they can say, “Well, wait a minute. Number one, I’m not coming into your office for a routine visit. You need to be able to talk to me via telemedicine. You need to have those practices, and you need to have technology that I can use.” Shiv, the last time I had to have a test, which was about eight months ago, first of all, I was admonished for bringing an e-card ID card. I didn’t bring my plastic ID card, and the receptionist just didn’t know what to do with me, or what to do with the fact that I didn’t have a plastic card that they could put on the copy machine. And then I needed to get a piece of paper that I had at home to them. And I said, “Well, if you just give me your email address, I’ll scan it when I get home and you’ll have it this afternoon.”


“No, we have a fax number,” she said,” or you can mail it.” And I said, “I don’t do fax.” And she goes, “Well, that’s the only thing we do.” So, I think we’re going to have to really think about this consumer expectation. We’re in a contactless payment world now, right? Yet somebody still wants you to bring an ID card. So, we have to think about that. And then the last thing, Shiv, that I would just suggest is information. There’s been a lot of information over the last seven months, and some of it has changed over that time period. I think consumers are really going to be looking for a trusted source of information, specifically when the vaccines start to get released.


Do I need to get one now? Should I hang back and wait? And what should I really do? And I think they’ll turn to providers. I think they’ll turn to health plans. I think they’ll want to hear from a variety of sources what they really need to do. So, those are the four areas, financially helping people out, customer expectations being raised, information, and really understanding that and making sure that it’s convenient for people to get access through safety. I think those are really the four areas are going to be on top of people’s mind, moving forward.
 

SHIV GAGLANI:
That’s fascinating. That’s a great, great breakdown. I definitely can concur with the health information. I mean, we’ve had so much conflicting information over the past few months, and I think consumers have lost faith in even some very trusted institutions because of the politicization of a lot of this information. One thing we even worked on very strongly at Osmosis is obviously not just provider and student education, but then we’re working with YouTube and we actually just released a video just yesterday on how the COVID-19 vaccine is being developed, because there’s so much misinformation around that. So, I could wholeheartedly agree with you on that. 

You have a lot of startup leaders and healthcare leaders on your podcast as well. I’ll take those in turn. Number one, what startups most excite you in this post COVID world, or during the COVID crisis and what are some of the obstacles that you think they should be focused on? And then secondly, we’ll go into the healthcare leadership and if you’re talking to a healthcare system CEO, what types of things do you say to her or him?
 

BETH BIERBOWER:
You’re right, Shiv. There are a lot of exciting startups that are out there, whether I’d be working with them or just things that I’m seeing out there. Some in the tele-behavioral health space, as an example, I think are really exciting. Some people are starting to take on logistics as an example. More startups helping vulnerable populations, startups around what I refer to as cultural competency, if you will, really focused on certain ethnicities and their needs as a population from a health perspective. So, there is no shortage of the types of startups that are out there. The one thing that they do really well is they identify a problem, and then they go after it. The one thing I think that startups will have to continue to focus on, and an obstacle they have, is oftentimes they bring a point solution to the table.

When you’re trying to work with a health plan or a major provider system, bringing a bunch of individual point solutions to the table can be actually more disruptive than it is beneficial. So I encourage startups to say, let’s step back, take a look at it, either from the health plan or the provider perspective, and turn how you actually fit into the bigger picture. Not just that you’re zeroing in here, and you’re not worried about anything else. You really have to become integrated. And I’ve seen the startups really step up during this time, as well. One of them is a home logistics company which actually helped out a major city where some of the smaller mom and pop shops had shut down during the pandemic. They were able to get durable medical equipment to people who needed walkers and nebulizers, and different things like that that were really, really important. And the tele-behavioral health provider example really expanded their capacity, and focused on people with even more serious mental illnesses who could have very easily fallen through the gaps. 

When I think about large companies and leaders of the health systems, the health plans, there’s no shortage of, I’m sure, issues to really focus on or to tackle. I think we have to continue to focus on prevention, early detection. I think we have to continue to focus on holistic care. I mentioned earlier social determinants of health. We really have to start to get to the root cause on some of this. And then of course you have to continue to focus on care delivery. I’d say, how could we be faster and smarter than that? How do we bring products to market faster? And how do we do it in a more efficient way? How do we really double down and invest in things like AI telemedicine, things that can actually help us get to rural areas, get things out to people in a much more efficient and faster timeframe?

SHIV GAGLANI:
I’ve definitely also been impressed with how startups have accelerated some of their initiatives or done completely different things. For example, one of my friends is the co-founder of an outdoor hiking apparel company called Cotopaxi — they’re sort of like Patagonia — and they adjusted because they had a supply chain in China and in Asia. They actually adjusted and started making masks very early on. A lot of companies I know have done that to raise the line as well, but clearly healthcare startups have done a lot over the past few months.

In some ways they’ve seen a lot of acceleration because, of especially telehealth. I mean, you mentioned behavioral telehealth a number of times. There was a really interesting article about how Talkspace has been trying to adapt quite a bit to enable their counselors to do interstate counseling. In that, scope of practice is a big issue, has been a big issue for years. And hopefully that’s something that’ll change as a result of COVID

So what are some of the lasting changes you think COVID will bring on the healthcare system? I know everyone talks about telemedicine. Everyone talks about the consumerization of healthcare, but what are some of the things that you think will be with us five years from now as a result of things that happened over the past few months?

BETH BIERBOWER:
Well, this may be more of a hope or a wish, but I do hope that we step back with our public health infrastructure. It’s easy to be a Monday morning quarterback, and I think people did a wonderful job with what they had. But I think we all know there’s lots of different information out there, lots of inconsistencies, and there are various levels of public health, right? There’s federal, there’s the state, there’s the local level, and it didn’t seem to be connected really well in one state doing one thing, another state doing something else. Yet somebody else, even in a county within the state, that’s doing something different than maybe what the government wanted. So I think this presents a real opportunity for us to step back, and look at our public health infrastructure, and determine where were the gaps and what can we do better? Where do we need to allocate our resources?

That doesn’t necessarily mean we have to throw more money at it. Maybe it’s about how we reallocate the dollars that we have. And as we think about that — because we know something will come again — people are going to be really hyped-up even this fall as we approach flu season. But how do we balance containing a virus like this with both the economic and the human impact? And then how do we start to have a framework for decision making? So, I think there’s a lot of opportunity here to really become best in class, in the world, if you will, at public health.

SHIV GAGLANI:
I couldn’t agree more. I like your analogy of not being a Monday morning quarterback. I mean, for a team to be successful there have to be different players. We talked about startups, we talked about payers, providers, but the patients themselves, right? We all have to play a role here.

So, we are a teaching company, a training company at our core at Osmosis. What are some of the places where you see the most knowledge gaps? Are there topics — like if you could snap your fingers and have us create courses on specific areas — what would you like to see us do?
 

BETH BIERBOWER:
I’d say two areas. Number one is, as I mentioned earlier, we don’t really think about the consumer in healthcare too much. If you look at other industries, they obsess over the consumer, right? Especially in retail. They think about their needs, their progress. What job are they trying to accomplish, if you will, and we don’t. It’s typically the providers at the center, and then we sort of revolve around that. And again, that’s not being negative because our providers are heroes. But when you start to think about what happens if I actually put the consumer in the center, because it’s not working this way. It’s too expensive. People are not adhering to treatment plans, they’re not taking their medication. So how do we have people that are going through clinical training, get them into customer experience a little bit.

Providers are on the front line, so they really have the impact. They really understand consumers, yet we don’t often really bring them into the loop. I would like to see more of that, in particular. And then just something I was thinking about personally that’s really helped me recently — I wish I had it earlier in my career – is I think it’s really important to know yourself. And when I say know yourself, I mean know your tendencies, know your strengths, and know your weaknesses because the earlier you can figure some of that out, I think you can optimize then your career, your path, your passions.

I’d like to share a quick story with you. Back in 2015, I was reading a book by a lady by the name of Gretchen Rubin. She writes on happiness and habits, and different things like that. The book was Better Than Before. And she had this chapter called The Four Tendencies. And these are your tendencies as it relates to meeting expectations. And it was like I was hit by a lightning bolt, because there’s a rebel, a questioner, an upholder and an obliger. And I realized, I’m an obliger. Here’s why that was important. As an obliger, I have no problem meeting anybody else’s expectations. If my boss wants something done, he or she gets it and never has to ask again, right? Doesn’t have to prod me. Anything for my family. I like to accomplish things for me too, but I’d always have a hard time with that because I was putting everybody and everything else first.


So once I learned that, and really got to know myself, I said, “Okay, I want to write a book.” Then I realized I had to set up an accountability structure, meaning I had to tell some friends that I was going to write a book. And then that way I would get it done, because I would never disappoint my friend. But if I kept to myself, that book might never get done. So, I just think it’s important early on to really know who you are, because that way, then you can take those deficiencies and figure out how to work with those, and how to then really be able to optimize what you can bring, not only to your professional life, but also to your personal life.

SHIV GAGLANI:
That’s a really interesting point. One of my anatomy partners in Hopkins medical school was on her third career. She was in her 30s, whereas most people in med school are one or two, or maybe three years out of college so they’re still kind of figuring themselves out and what they want out of life and what their values are. But she knew exactly what she wanted. She knew who she was. She knew what she wanted to do. And obviously people in their 40s, 50s, 60s are still obviously changing, but the pace of change seems to slow down after your 30s or so. And so, I’m a big fan of people taking the time to know who they are, and all that. I mean, it’s just like the social determinants of health are really important. Having healthcare heroes or providers who truly understand what drives them, and how to take care of themselves first and fill their cup. 

So, what advice would you give to our audience? Mostly current and future healthcare professionals, or really anyone considering a career in healthcare. What type of advice would you like to give them?

BETH BIERBOWER:
A couple things. First thing is, I would say step in and step up. By that, what I mean is become a go-to person. Early on in my career I was known as the go-to person and people would say, “Well, let’s give it to Beth. She’ll figure that out.” And it didn’t mean that they were dumping on me, but it meant that if there was a unique project or something like that, but they didn’t know what to do with, they knew that I would take great care. I would investigate, I would learn and I would bring a good solution to the table, and why that was important is it gave me the opportunity to get exposure to senior leaders in the organization, number one. And number two, it allowed them to see my capabilities. So I would say, particularly if you’re earlier in your career, trying to really be that go-to person, but continue as you progress to figure out how you can serve on cross-functional committees, and different things like that to get that exposure.

Second thing I’d say is, your career is yours for a reason. It’s nobody else’s. People may help me from time to time, but nobody’s going to guide you and say, “Here’s what you do next. ” You have to build a roadmap, and then you take that roadmap. And what I encourage people is I say, “Listen, where do you want to be five years from now?” And then back down from that and say, “Okay, well, gosh, if I want to be vice president of X, do I have all the skills and capabilities? What gaps do I have?” Well, if I have a gap here, and maybe that means my next role, if I want to be vice president of provider contracting, maybe my next role is to get into the provider area and fill in that gap. Go out in the field and be a provider contractor as an example. And then have those dialogues with your leader on a quarterly basis about where you want to go, what you want to do, how you’re performing, where they see your gaps are.

I always tell people I’m a lifetime Weight Watchers member. And we have a saying, “failure to plan is a plan to fail.” So, once you have a plan you can share that with your boss and other leaders in the company. Then they’re going, “Oh, it’s succession planning time, or we’re opening. Let’s put Beth in here. Let’s put Shiv in here because I was talking to him that this is really where he wants to go.” So I think that’s really, really important. 

The other thing I would say is — I have two more things — be intellectually curious. Just absorb everything. I wish, if I were in an interview interviewing somebody, I wish I could reach back and talk with their parents and ask them if that person was a pain in the butt as a child. Because if they said yes, because he or she were always asking “Why, why, why?” I’d try that person on the spot, right? Because they’re intellectually curious. Be that inside your industry and outside your industry. Be a well-rounded person. Learn what consumers are talking about. Especially looking at other industries, there’s lots of support from other industries back into healthcare. And then the last thing I would say is, please, please have a growth mindset. Think like a rookie, and the minute you think you’re the smartest person in the room, you’ve stopped learning, and that’s a problem.

SHIV GAGLANI:
That’s clear. I mean, in your intro I mentioned that you have been an advisor, a sponsor and advocate for many people throughout your career. It’s clear from just that answer that you’ve helped a lot of people by giving them advice like that. The growth mindset really resonates. We actually have a value at Osmosis — one of our six core values is “reach further”, which is all about obviously trying to improve yourself. And I love that mathematical equation of compounding, where if you become 1% better every day, at the end of the year, you’re 37 times better. And so very, very interesting. Since we’re coming up on time, is there anything else you’d like to share with our audience that I haven’t asked you about today?

BETH BIERBOWER:
I would just say, you are the next generation of healthcare leaders and healthcare professionals, and we’re counting on you for the future. So, I hope that you embrace your passion, and I hope you are a continuous, curious, lifelong learner because you’re the ones that are going to be leading this industry going forward. So, take full advantage of it and give it your best.

SHIV GAGLANI:
With that, those are some inspiring words. So Beth, thanks so much for taking the time to be with us today.

BETH BIERBOWER:
Thank you very much for having me, Shiv. I really appreciate it.

SHIV GAGLANI:
I’m Shiv Gaglani. Thank you to our audience for checking out today’s show, and remember to do your part to flatten the curve and raise the line since we’re all in this together.

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