The first change to the healthcare system I would recommend would be proliferating the usage of value-based healthcare payment models. This kind of healthcare model rewards medical providers and the companies that employ them for actually helping to improve patient’s health outcomes. This lies in contrast to the Fee-for-Service model that incentivizes medical providers to deliver services that may be costly, unnecessary, or ineffective. I was previously working in a medical practice that provided alternative treatment options for patients experiencing chronic pain. Invariably, when our physicians would refer a patient to an orthopedic surgeon for a consult, the resulting recommendation was “let’s cut.” The data doesn’t support surgical solutions for most patients however, so we’re left understanding that we’ve incentivized physicians to provide services like any other profit driven business. When you take your car to a mechanic, they’re likely to find a reason to open up the hood and do some work. We don’t want to operate under this philosophy for our health and well-being.

As a part of my interview series with leaders in healthcare, I had the pleasure to interview Ryan Linden, CEO and Executive Director of Silver State Health Services. Ryan currently oversees more than 65 medical and mental health professionals who provide valuable medical care, resources and assistance to the underserved communities in Southern Nevada. Linden directs the nonprofit Federally Qualified Health Center (FQHC), which offers affordable access to high-quality health care, including medical, mental health and social services.

Prior to accepting the position of executive director, Linden previously served as the CEO of Silver State Behavioral Health Services, Acumen Laboratory, LLC, Precision Laboratory Services, and Wellcare Home Health, LLC, where he gained expert insight into the diverse sectors of healthcare operations from marketing to system management.

A graduate of Oklahoma State University, Linden earned his Bachelors of Science degree in Political Science. Shortly thereafter, he joined the Mind Body Solutions private medical practice, where he worked his way from psychiatric technician to office manager. He eventually became the operations manager while having the opportunity to learn from the bottom up and experience the intricacies of today’s health care systems.

Linden is a member of the National Alliance to End Homelessness, committed to preventing and ending homelessness in the United States, and serves on the Southern Nevada Homeless Continuum of Care (SNH CoC) board, which is comprised of community representatives working together towards the mission of eliminating homelessness in Southern Nevada.

Linden, alongside Silver State Health’s executive board, leads efforts to acquire federal grants in order to continue Silver State Health’s mission to provide high quality and accessible healthcare and mental health services in Southern Nevada, with future plans to serve and expand into rural Nevada communities.

Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?

I would like to think that I have been groomed for this career path far before I ever realized it was my passion and vocation. Growing up the son of a psychiatrist and a psychotherapist, mental health and health care have always been present at the forefront of my life. It’s from this upbringing that I developed an equal sense of admiration for healthcare professionals and general disinclination for the system in which they practice. While studying government systems and management in school, it became apparent that I had the unique perspective and opportunity to make changes to a system fraught with misguided goals and ineffective delivery models.

Can you share the most interesting story that happened to you since you began leading your company?

The most interesting story happened just this last Christmas. Unfortunately, Las Vegas ranks amongst the nation’s leaders in its homeless population. Over the past two years, our organization has made it a part of its mission to provide medical and mental health services to this vulnerable population. Despite our best intentions however, it quickly became clear bringing someone aboard our team that has experienced homelessness themselves would allow us to more effectively reach our patient base. Over the course of one year, we were able to train and elevate one of our patients who had frequently utilized our healthcare services. Through the generous donations of our staff, we were able to provide him with temporary housing over the holidays. Following the holidays, he was trained and made a paid staff member through our organization, essentially ending his state of homelessness. Because we operate on a “housing first” model, this was very special for us.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

While not amusing at the time, the funniest mistake I’ve made was not having our lawyer fully review a sub-lease document. Long story short, the untimely passing of our sub-lessor left relations between our companies strained in the wake of his death. His estate took it upon themselves to enter our office over the weekend, remove our belongings, and change the locks, all without notice. Let me tell you, there’s nothing quite like arriving at work on Monday to a stolen Christmas tree from the lobby, changed locks, confused patients and employees, and police officers scanning the premises for burglars who may still be on premises. My lawyer advised me to tattoo on my arm “call your lawyer before you sign anything.”

What do you think makes your company stand out? Can you share a story?

I think what makes our company stand out is our amazing staff. There are a growing number of health care organizations providing amazing medical services in the Las Vegas area. However, in my experience, it would be a far reach to find a more compassionate and loving staff than we’ve developed at Silver State Health Services. So much of healing is about the intangible connections we have to our healthcare providers and ancillary staff. We strive to convey a sense of belonging and inclusion for our patients, many of whom consider our offices to be a second home for them.

What advice would you give to other healthcare leaders to help their team to thrive?

I think that the number one job of a leader is to understand the individual passions of their team. We all have our own motivations for going to work each day and it’s through understanding these motivations that a leader can effectively foster the unique talents that a diverse team brings to an organization. Additionally, communication is key. Sometimes we over-communicate, sometimes we are too hands-off. I think the most effective leaders are uniquely attuned to the communication styles and needs of their team members and work to ensure everyone has a unified understanding of the mission.

Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?

Ultimately the reason why the US healthcare delivery system is ranked so poorly is due to our aversion to universal healthcare. While this perception is changing rather rapidly over the past decade, many Americans find universal healthcare to be antithetical to the capitalistic nature of our country. It’s my opinion that Americans have largely been held hostage by insurance and pharmaceutical companies who have obligations to their investors to make the largest returns, not necessarily the best health outcomes. The rest of the developed world doesn’t conflate the wellbeing of their citizens with the financial gains of corporations. This primary issue can be broken down a bit further.

It’s estimated that Americans spend two to six times more than other citizens around the world for pharmaceuticals. Drug companies attribute these high pharmaceutical costs to the research and development for innovative drugs. While research and development may be a contributing factor to overall cost, I believe the root cause of the global price disparity lies in our government’s inability or unwillingness to regulate prices. Instead of pharmacy benefit managers (PBMs) negotiating drug prices, our government could play the middle man. If our government had a larger direct financial liability for its healthcare costs, we would see prices of drugs dramatically reduced as seen in other countries.

Many consider specialty healthcare services in the United States be top notch if you can afford it. In fact, people from around the world visit the US every year to receive cancer treatment and various surgical procedures due to their renown excellence. It’s this focus on medical specialties that in my opinion leaves primary medical services in a deficient state. It seems that we’ve all but forgotten the “primary” nature of primary care and instead, focus on the treatment of disease rather than its prevention. This treatment over prevention model supports higher healthcare costs and lower health outcomes for patients.

High administrative costs and time demands in the healthcare sphere encumber healthcare professionals from providing cheaper and more effective treatment. It’s estimated that 20–30% of healthcare costs are attributed to administrative personnel in the United States. Lucky for us, Physicians go to school to save lives, not necessarily run a business. But the increasing operational demands placed on healthcare professionals only mean that doctors and their staff are spending more time talking to insurance companies, and less time treating patients.

You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

The first change to the healthcare system I would recommend would be proliferating the usage of value-based healthcare payment models. This kind of healthcare model rewards medical providers and the companies that employ them for actually helping to improve patient’s health outcomes. This lies in contrast to the Fee-for-Service model that incentivizes medical providers to deliver services that may be costly, unnecessary, or ineffective. I was previously working in a medical practice that provided alternative treatment options for patients experiencing chronic pain. Invariably, when our physicians would refer a patient to an orthopedic surgeon for a consult, the resulting recommendation was “let’s cut.” The data doesn’t support surgical solutions for most patients however, so we’re left understanding that we’ve incentivized physicians to provide services like any other profit driven business. When you take your car to a mechanic, they’re likely to find a reason to open up the hood and do some work. We don’t want to operate under this philosophy for our health and well-being.

Another change that I see is increased regulation of healthcare monopolies. When large hospital groups consolidate, it allows these groups to raise prices for its services due to the lack of realistic patient choice. A study was conducted in 2016 by the Healthcare Cost Institute that revealed that the price variations between hospitals across the country followed no logical economic model. For example, patients in Sacramento California were paying $57,000 for the same knee replacement procedure that is provided for $30,000 in Riverside California, just 400 miles away. The solution here is increased cost transparency for all healthcare related costs. If we’re going to operate under a Fee-for-service model, the least we can do is relay the price of the service prior to providing it.

The geography of the United States presents certain challenges not experienced by the other 10 leading healthcare systems across the globe. The health outcomes of rural peoples versus those living in an urban environment are astounding. The solution that I and many others see is improved access to healthcare for all Americans. The relatively quick adoption of Tele-Health services in the US stands to be one of the largest changes to our delivery model over the past two decades and serves to increase access to those living in rural communities. As one of a growing number of millennial healthcare executives, I believe I have more intimate insights into the changing demands newer generations place on our healthcare system. When we describe the nature of tele-services to our patients in the clinic, I get wildly varying responses based upon age generally. While older adults are accustomed to the look, feel, and service of a brick-and-mortar clinic, newer generations are opting for convenience over everything. With the rollout of 5g telecommunication speeds later in 2019, we have the opportunity to take healthcare to a place not yet imagined.

Increased attention to supportive social services is a clear path towards better health outcomes. One of the more impactful studies I’ve read centers around Adverse Childhood Experiences (ACE). The study correlates stressful or traumatic events in a person’s childhood to increased risk for a wide range of physical and mental health issues throughout their life. Understanding this basic principle, we aim to increase the amount of enabling services tied to primary care delivery. I believe that we will see a dramatic rise in positive health outcomes should healthcare providers begin to view a patient’s health outside of the just the physical body, but to also factor in their environment, family life and past experiences.

The education and unique skills that a physician in the United States must possesses is honestly staggering. Their breadth of knowledge and ways they analyze pathology are, in part, due to the extensive years of secondary education they’re required to undergo to become a professional physician. By 2030 however, the projected shortage of physicians in the United States is expected to reach 100,000. Continued and increased usage of midlevel providers in healthcare is one part of the solution. As a result of the Affordable Care Act and a growing lack of medical providers, more and more Americans are receiving primary healthcare from advanced nurse practitioners and physician assistants. Not only does this serve to decrease costs, as these midlevel practitioners are often reimbursed less for the same services, but it also increases access to healthcare. Physicians should be further encouraged to pursue sub-specialty training and share the burden of primary healthcare with a growing number of midlevel providers.

Ok, its very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

  1. Healthcare is one of the most salient political issues our country faces today. I would encourage every individual to communicate with their local political leaders and support politicians who favor innovative healthcare reform.
  2. Healthcare costs drive the costs of other goods up as companies have historically supplemented payments for their employee’s health insurance plans. If corporations pushed for universal health coverage, their financial liabilities will decrease substantially.
  3. Communities can utilize and advocate for Federally Qualified Health Centers (FQHC) and other non-profit health centers that focus on prevention and low-cost, high-quality medical services not based on a Fee-for-Service reimbursement model.
  4. Leaders can continue to raise awareness about the growing disparity between the cost of healthcare and its overall efficacy.

As a mental health professional myself, i’m particularly interested in the interplay between the general healthcare system and the mental health system. Right now we have two parallel tracks mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?

I think this status quo is one of the most harmful perspectives of our modern healthcare system. More research surfaces each year that highlights the benefits of integrative healthcare solutions. Luckily, like other Federally Qualified Health Center’s (FQHC) around the country, Silver State Health is designed to treat the individual comprehensively, offering both primary care and behavioral health services in one place. All patients, whether they are being seen for medical or behavioral reasons, undergo mental health screenings and assessments. From there, our providers can create a more comprehensive action plan with a set team of specialists, from psychiatrists to clinical social workers, therapists and primary care physicians. Many people don’t realize the environmental, socio-economic status, home life, diet, exercise, and smoking can have on a person’s mental health, which is all the more reason to encourage medical and mental health providers to collaborate.

How would you define an “excellent healthcare provider”?

An excellent healthcare provider perceives and treats an individual as an individual and not just a patient. Our bodies and minds are highly complex, ever-changing, and brilliantly unique. Modern healthcare is about utilizing data about the health of us all, to individually tailor a solution for each person.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

A mentor of mine once said, “there is no one model life by which humans should aim to live by. Whichever model you choose, may it contain an abundance of love.” John Coltrane might argue that love is supreme. I’d like to think that the demonstration of love can pervade the sickest of people and systems.

Are you working on any exciting new projects now? How do you think that will help people?

Silver State Health Services is excited to join forces with the largest bilingual Spanish speaking behavioral health company in Nevada. To this amazing team of psychotherapists and supportive ancillary staff, we’re adding Spanish-speaking pediatric, psychiatric, and primary care providers to fully integrate the clinic and act as a health resource hub for the Latino community. It continues to be our vision to deliver culturally competent and relevant health services to the increasing ethnically diverse population of Nevada. To this end, we are proudly opening our first Asian-centered medical clinic in June of 2019 that seeks to serve this diverse group of peoples with providers who are both culturally sensitive and linguistically aligned with the patient base.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

Recently I’ve been reading “The Innovator’s Prescription: A Disruptive Solution for Health Care” by Clayton Christensen. I enjoy looking outside of the healthcare sphere for inspiration on how to disrupt marketplaces. If we look at some of the most impactful companies to come out of this country over the previous decade, they’ve largely been industry disrupters in some way or another. If the government isn’t going to disrupt the current healthcare system in favor of lower costs and higher efficacy, then private industry will have to lead the way.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

As a millennial, data and technology are always at the forefront of my mind. Today I see our governmental systems collecting data on us through various agencies like the U.S. Department of Housing and Urban Development (HUD), the Internal Revenue Service (IRS), the U.S. Department of Education and Centers for Medicare & Medicaid Services (CMS). To further our ability to help and benefit all people, I’d like to see greater collaborative efforts made to corelate disparate data sources. If we could utilize this data and incorporate technology to better understand the underlying factors of a person’s health. Just like in healthcare, when we silo people and systems, we generally miss the macroscopic view that comes from systems integration.

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About the Author:

Originally from Israel, Limor Weinstein has been anorexic and bulimic, a “nanny spy” to the rich and famous and a Commander in the Israeli Army. Her personal recovery from an eating disorder led her to commit herself to a life of helping others, and along the way she picked up two Master’s Degrees in Psychology from Columbia University and City College as well as a Post-Graduate Certificate in Eating Disorder Treatment from the Institute for Contemporary Psychotherapy.

Upon settling in New York, Limor quickly became known as the “go to” person for families struggling with mental health issues, in part because her openness about her own mental health challenges paved the way for open exchanges. She understood the difficulties many have in finding the right treatment, as well as the stigma that remains so prevalent towards those who are struggling with mental health issues. She realized that most families are quietly struggling with a problem they’re not comfortable talking about, and that discomfort makes it much less likely that they will get the help they need for their loved ones. She discovered that being open and honest about her own mental health challenges took the fear out of the conversations. Her mission became to research and guide those families to the highest-quality treatment available. Helping others became part of her DNA, as has a commitment to supporting and assisting organizations that perform research and treatment in the mental health arena.

After years of helping families by helping connect them to the right treatment and wellness services, Limor realized that the only way to ensure that they are receiving appropriate, coordinated and evidence-based care would be to stay in control of the entire treatment process. That realization led her to create Bespoke Wellness Partners, which employs over 100 of the best clinicians and wellness providers in New York and provides confidential treatment and wellness services throughout the city. Bespoke has built its reputation on strong relationships, personalized, confidential service and a commitment to ensuring that all clients find the right treatment for their particular issues.

In addition to her role at Bespoke Wellness Partners, Limor is the Co-Chair of the Academy of Eating Disorders. She lives with her husband, three daughters and their dog Rex in Manhattan.

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