For The Record with Bennett Clark, Chief Medical Officer, Livio Health

July 23  

Dr. Bennett Clark joined Livio Health from OneOme, where he led efforts to improve the safety and affordability of medical care through personalized prescribing. Dr. Clark’s clinical background is in internal medicine and hospital medicine. 

Prior to joining Livio Health, he served on faculty at Yale and Johns Hopkins, where his research focused on transitions of care and medical education. Dr. Clark earned his medical degree from Stanford and completed his residency in the Osler Program at Johns Hopkins, where he went on to serve as a Chief Resident and Assistant Chief of Service.

What is Livio Health’s mission?

Livio Health’s mission is to provide care inspired by people’s lives, not their diagnoses. That means making time to learn about our patients’ families, hobbies, and social networks. It means focusing on personal goals, not just medical outcomes. Our healthcare system devotes a tremendous amount of money and expertise to achieving a narrow range of biomedical endpoints. At Livio, we support those efforts, because we know they make a difference in people’s lives. We also know there is more to medicine than pills and numbers. Providing care inspired by people’s lives means that sometimes we put the person ahead of the numbers.

What was your original plan for 2020 and how has that changed?

Livio went in a new direction at the beginning of 2019 by starting a home-based supportive and palliative care service for patients with serious illness. In the last six months of 2019, we grew that service from one patient to more than 350 and added nearly a dozen clinicians. For 2020, we were focused on expanding our supportive and palliative care service to Greater Minnesota using an in-person care model that was almost identical to our Metro Minnesota model.

Like everyone in healthcare, we’ve had to adjust our tactics to reduce COVID-19 risk for our patients and our team members. We moved the majority of our care to video conference platforms and accelerated our implementation of telehealth technology in Greater Minnesota. We’re still available 24/7 for in-person evaluation of clinical changes but any time we can use technology to reduce risk and minimize response time, we do it. Our Blue Cross and Blue Shield Medicare Advantage members in Greater Minnesota will also have 24/7 access to an expert provider, but they’ll be in contact via telehealth for the remainder of 2020.

On the plus side, the pandemic allowed us to reimagine some foundational clinical practices. How do you build trust over videoconference? How can you do a quality physical exam for a patient in International Falls from an office in Minneapolis? How do you talk about the risks and benefits of hospitalization during a viral pandemic? Because we’re not weighed down by a traditional fee-for-service revenue model, we have amazing flexibility to tackle these questions.

Given the breadth of the issues you could address, how do you narrow your focus?

We have to stay disciplined from both a clinical and a business standpoint. Our clinical focus comes from the gaps in the healthcare system — things like short-term access to counseling and mental health support, proactive monitoring at times of high clinical risk, multidisciplinary pain and symptom management, caregiver support, and advance care planning. These are clinical moments when trust and time matter. Even when patients trust other providers, there usually isn’t time in a fee-for-service setting to dig into these issues. That’s where Livio comes in. We’re not here to replace our patients’ existing providers. We’re here to do the things that make a difference but aren’t supported in traditional care. Staying in that lane and listening to patients’ priorities keeps us clinically focused.

From a business standpoint, we’re disciplined about sticking with services that build provider-patient trust. There are only a handful of ways to move the needle in healthcare — you can discover a cure, you can make things cheaper and more accessible, or you can empower people to make smart decisions. That last one is our wheelhouse. Livio focuses on people’s lives and values so they can make smart healthcare decisions. We can only do that if we’ve earned our patients’ trust. One-off, transactional services, which are a huge part of the industry, don’t really make sense for us.

What are the biggest challenges your organization faces when it comes to realizing health equity?

One big challenge in combating systemic injustice in healthcare is a lack of upstream targets. We know about some of the downstream targets — life expectancy, pain prescribing, blood pressure control, and infant mortality. To fix those inequities, we need a better handle on the upstream factors that perpetuate inequity in the first place. At Livio we’re updating our data systems so they do a better job of tracking race, along with other important non-medical predictors of health outcomes. There’s still a huge amount of work to do once we’re over that hurdle. For one, we have to accept that imperfect data on the links between race and health outcomes isn’t an excuse for inaction. It’s not like we’re waiting for a comprehensive model of cancer biology to start treating leukemia. We need to take what we have, adopt meaningful equity metrics, and incorporate them into everything we do.

Have 2020’s major events fundamentally changed what you want the organization to focus on going forward?

Absolutely. We’ve learned so much from our own team about where we can do better in promoting racial justice. That’s brought a new sense of urgency to the process of defining and pursuing the equity outcomes we were just talking about. I’m hopeful that 2020 brought us to a moment in which health equity becomes a core goal for businesses across the industry, on par with revenue, patient recruitment, etc. That focus is much stronger in our organization now than it was a year ago and I want us to preserve that urgency going forward.

What does leadership look like to you?

I was incredibly fortunate to train at Johns Hopkins’ Osler program, which is a pipeline for healthcare leaders. It’s a place that asks for incredible effort and sacrifice, but one that rewards you with experience and confidence that are hard to match. I could go on and on about the parallels between good doctors and good leaders, but the most important is probably humility. In the situations that matter most, there’s an inverse correlation between the certainty with which doctors draw conclusions and the probability that they’re correct. The best leaders and the best doctors are people who understand that probability is the rule, that we’re always moving in a gray area. If you can accept that fact and learn to act with purpose and confidence despite it, you’re poised to be an effective leader.

What is the best advice you have received in your career? What is the worst?

My best career advice probably came from my wife. She’s the one who finally convinced me that you can do anything, but you can’t do everything. Exceptional people make their work look effortless. It’s the same with athletes, doctors, business leaders — any field you can think of. I used to look that effortlessness and believe I could match it without doing too much work. My wife spent about a decade helping me understand all the effort that goes into looking effortless, and that I really need to focus.

The worst career advice was something I internalized in high school, which was that I wasn’t a “math science person.” For a long time, that assumption kept me from thinking about a career in medicine. I’ve seen lots of incredibly talented people pigeon-hole themselves. They think they’re not the right fit for the work they want to do, when in reality people with all kinds of styles and backgrounds can get results.

What have been the most rewarding moments in your career?

Seeing the success of people I’ve taught or mentored. Like most of us, I usually show up to work with a business objective or a clinical goal. But when I look back on different periods in my career, it’s the people I worked with who stand out even more than the mission I was working for. Every now and then you get an opportunity to give someone a nudge forward in their career. Seeing people take that momentum and accomplish something they love and that will make the world a little bit better — that’s about as good as it gets for me.  

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