EP432: The Knifepoint Intersection of Margin and Mission and the Peril of Cutting Clinical “Waste,” With Kate Wolin, ScD
Relentless Health Value™March 28, 2024
38:1835.05 MB

EP432: The Knifepoint Intersection of Margin and Mission and the Peril of Cutting Clinical “Waste,” With Kate Wolin, ScD

For a full transcript of this episode, click here.

First of all, I just want to start out this pod and really thank everyone listening and for showing up for a show like this one. You do it and you are here because you care about patients/members.

It’s just so easy to feel like we’ll never be able to do enough, and that’s a rough, rough feeling. Please take a moment to truly hear how grateful I am for you being here and for doing all that you do and that you try to do.

I saw on the interwebs the other day a Marcus Aurelius quote. What he said was, “Be satisfied with even the smallest progress.” And I think this is really important to remember because nobody working in the healthcare industry, especially today, is ever probably gonna get anything close to a perfect solution. So instead, just aim for progress—even the smallest amount—and feel good about that, please.

This show is an important one for anybody either in the business of healthcare delivery or buying healthcare delivery services. It’s an exploration of what works and what doesn’t work and how what works can easily become what doesn’t work in the face of the real world.

This peril of cutting clinical “waste” perilousness all starts with the whole “Hey, let’s make some money, so we gotta scale and be efficient. We gotta do our thing at as low as possible a cost and maybe grow as fast as possible. We gotta keep our investors happy or pay off the debt we got saddled with or pay that giant management fee we’re being charged or compensate the C-suite at the level they’ve grown accustomed to.” So again, the “let’s be efficient and get everything repeatable” has entered the building.

The first point my guest today, Kate Wolin, ScD, makes about all of this—and this is exactly the same point that Rik Renard made in episode 427—efficient to what endgame? Now, it turns out, surveys show, only a small, small percentage of healthcare delivery solution providers are measuring outcomes of pretty much any kind.

So, how do we even know if cutting so-called waste is actually waste at all? I mean, in the absence of any actual measures—here’s a hypothetical for you—someone could look around: “Hey, I see these nurses. They’re all just sitting around chatting with patients and, I don’t know, talking about throw rugs? What is this? An episode of HGTV? Who cares if a patient with diabetic neuropathy has throw rugs in their hallway? Let’s tell these nurses chop-chop, get them on the computer using AI to be efficient, right? Let’s get rid of that clinical waste.”

I just made a point in the most sarcastic way possible, but the bottom line is this: It’s actually really efficient to not engage patients in these ways, right? Patients, they talk slow, they ask questions that seem irrelevant, and they’re time-consuming. It’s very efficient to not build relationships or foster trust or, I don’t know, assess fall risks … but whatever is going on is also going to fail in that model—from a patient outcome standpoint at least.

Here’s a quote from Sergei Polevikov, with some light edits. He wrote on LinkedIn: Primary care is not scalable in the same way as Scrub Daddy or Bombas Socks. That’s something not taught in MBA and CFA programs. Someone should have told Walgreens, CVS, Amazon, and Walmart.

They also probably should tell a whole bunch of point solutions and payers. Also, some health system execs or pharmacy leaders might also want to get that memo.

What I really liked about the conversation with Kate Wolin in this healthcare podcast is that she retains optimism in the face of all of this. She offers advice for how to navigate the balance between mission and margin in a way that’s better for patients and also sustainable financially. She talks about three points:

1. Founders and investors being in alignment and the essential nature of that

2. The importance of having clinical leadership and a team dynamic that enables innovation but in a clinically sound way

3. How you gotta measure what matters and do it in a way that inspires a mission-driven culture

If we’re talking about relevant shows to listen to next after you listen to this one, please do not forget episode 331. This is where Al Lewis teaches us how to evaluate wellness vendors and health solutions, but it also teaches us how to be a good wellness vendor or health solution. Also, do come back and listen to the encore with Jerry Durham next week about front desks and the total care experience. Lots of really bad avoidable things happen if the front desk isn’t considered—and it isn’t often considered. For sure, also listen to the show with Kenny Cole, MD (EP431); that’s a must-listen. Then again, the show with Rik Renard (EP427) came up several times in this episode. The show with Jodilyn Owen (EP421) also gets brought up; that’s a great cautionary tale there to keep in mind for mission-driven entrepreneurs and investors. And then, I also recommend J. Michael Connors, MD. He writes a lot of stuff in a newsletter along these lines.

Last, last, last … Please go to our Web site and subscribe to the weekly email. I am planning on doing a few invite-only sessions for email subscribers. Plus, the weekly email is a really very convenient way to get the episode transcripts and stuff. And if you don’t get it, you’re making your life less efficient. So, go fix that.

Kate Wolin, my guest today, trained as a behavioral epidemiologist and has done research in chronic disease prevention and management. She launched and led a digital health start-up and sold it to Anthem. She’s been in the digital health start-up space largely at the intersection of science and product strategy ever since.

You can learn more by following Dr. Wolin on LinkedIn.


Kate Wolin, ScD, is a behavioral epidemiologist who left academic medicine to launch and lead a digital health start-up, which she bootstrapped to profitability before selling to Anthem. She has since been a C-suite leader, investor, and advisor to digital health start-ups and enterprise organizations on bridging clinical and behavioral science with product strategy and execution. She has been named as a Forbes Healthcare Innovator That You Should Know and a Notable Woman in STEM by Crains. Dr. Wolin is a Fellow of the Society of Behavioral Medicine and the American College of Sports Medicine and teaches entrepreneurship at Kellogg.


06:24 Irrespective of money, what works in clinical care and population healthcare?

09:51 EP361 with Carly Eckert, MD, PhD(c), MPH.

10:26 Why is creating a gathering place and sense of community important in clinical care?

12:46 “Sometimes, we make this about the clinical provider. It always makes me think about the rest of the people in an ecosystem that create trust.”

13:49 EP297 with Jerry Durham.

14:11 Where can things go wrong when we start to think about the margin in respect to the clinical care that works?

16:47 EP427 with Rik Renard.

19:35 “We’re actually very unspecific in what we’re trying to achieve a lot of times in these digital health programs.”

24:00 “Are you aligned as a founder, as a business with your investors on the pace of growth and what is feasible … ?”

25:30 Why is Dr. Wolin optimistic about achieving growth and still providing value?

28:17 Why is it important to ask why something is being done?

30:39 EP421 with Jodilyn Owen.

34:35 How are people motivated, and how can you use that to reduce turnover?

35:21 Why measuring what matters and communicating that is important.


You can learn more by following Dr. Wolin on LinkedIn.


Kate Wolin, ScD, discusses #clinicalwaste on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation


Recent past interviews:

Click a guest’s name for their latest RHV episode!

Dr Kenny Cole, Barbara Wachsman, Luke Slindee, Julie Selesnick, Rik Renard, AJ Loiacono (Encore! EP379), Nina Lathia, Marshall Allen, Stacey Richter (INBW39), Peter Hayes


balance,clinical waste,healthcare,innovation,mission and margin,outcomes,